1
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Belhoste M, Allenbach G, Agius T, Meier RPH, Venetz JP, Corpataux JM, Schneider A, Golshayan D, Prior JO, Déglise S, Nicod-Lalonde M, Longchamp A. Role of post-transplant graft scintigraphy in kidney donation after circulatory death. FRONTIERS IN TRANSPLANTATION 2022; 1:1065415. [PMID: 38994379 PMCID: PMC11235226 DOI: 10.3389/frtra.2022.1065415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/29/2022] [Indexed: 07/13/2024]
Abstract
Background There is no consensus on how to predict post-transplant function of donation after circulatory death (DCD) kidneys. Thus, we aimed to identify renal scintigraphy parameters that could predict 1-year kidney function. Methods In this single center study, we included all consecutive DCD kidney recipients between 2013 and 2021 (n = 29). Patients who did not have a scintigraphy within 10 days of transplantation (n = 3), recipients of multiple organs and less than 18 years old were excluded (n = 1). Primary endpoint was the estimated glomerular filtration rate (eGFR). Results Median eGFR and serum creatinine at 1 year were 67 µmol/L (56-81) and 111 ml/min (99-132), respectively. Among parameters tested, the 3rd/2nd-minute activity ratio had the best diagnostic performance (AUC: 0.74 and 0.71, for eGFR and creatinine) 1 year post transplantation. Using 1.21 as the best cut off, the 3rd/2nd-minute activity ratio specificity and sensitivity to predict eGFR >60 ml/min was 0.82 and 0.83. Renal function was significantly better at 1 week, 3, 6, and 12 months after transplantation in patients with 3rd/2nd-minute activity ratios above 1.21. Conclusion This study suggests that the 3rd/2nd-minute activity ratio can predict graft function at 1 year. The benefit of post-transplant scintigraphy should be further validated in a prospective cohort.
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Affiliation(s)
- Manon Belhoste
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Gilles Allenbach
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Thomas Agius
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Raphael P. H. Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jean-Pierre Venetz
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Marc Corpataux
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Antoine Schneider
- Adult Intensive Care Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Déla Golshayan
- Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - John O. Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Déglise
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Nicod-Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Alban Longchamp
- Department of Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
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2
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Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes. Transplant Direct 2022; 8:e1414. [PMID: 36406898 PMCID: PMC9671751 DOI: 10.1097/txd.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/25/2023] Open
Abstract
UNLABELLED Delayed graft function (DGF) after kidney transplantation is associated with higher rates of acute rejection and poor graft survival and outcomes. Current DGF definitions based on posttransplant need for dialysis are not standardized and there are no objective methodologies for quantifying DGF severity. METHODS Using Organ Procurement and Transplantation Network data, we examined DGF, and used recipient serum creatinine at discharge as a correlate of renal function and DGF severity (mild: <2.5 mg/dL; severe: ≥2.5 mg/dL). The associations between donor and recipient factors and DGF severity were quantified using logistic regression. We also examined the associations between DGF severity and long-term recipient outcomes, adjusting for potential confounders. RESULTS A predictive model using donor and recipient factors had a reasonably good ability to discriminate mild (low creatinine) versus severe (high creatinine) DGF (c-statistic of 0.70). In Cox regression, DGF and creatinine at discharge were both independently associated with long-term outcomes, yet their effects differed depending on the outcome (graft function, death-censored graft function, recipient mortality). Our findings suggest that having DGF, but with relatively good renal function (creatinine <2.5) at discharge, may be less deleterious on graft and recipient survival compared with severe, prolonged DGF, which was associated with a decreased median graft survival of ~2.6 y compared with no DGF with low creatinine at discharge. CONCLUSIONS Our novel DGF severity stratification identified unique factors associated with DGF severity, along with DGF's association with long-term graft and patient survival. The adverse cost and outcome implications of severe DGF warrant additional investigation to improve kidney transplantation practice.
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3
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Matas AJ, Helgeson E, Fieberg A, Leduc R, Gaston RS, Kasiske BL, Rush D, Hunsicker L, Cosio F, Grande JP, Cecka JM, Connett J, Mannon RB. Risk Prediction for Delayed Allograft Function: Analysis of the Deterioration of Kidney Allograft Function (DeKAF) Study Data. Transplantation 2022; 106:358-368. [PMID: 33675321 PMCID: PMC8380757 DOI: 10.1097/tp.0000000000003718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Delayed graft function (DGF) of a kidney transplant results in increased cost and complexity of management. For clinical care or a DGF trial, it would be ideal to accurately predict individual DGF risk and provide preemptive treatment. A calculator developed by Irish et al has been useful for predicting population but not individual risk. METHODS We analyzed the Irish calculator (IC) in the DeKAF prospective cohort (incidence of DGF = 20.4%) and investigated potential improvements. RESULTS We found that the predictive performance of the calculator in those meeting Irish inclusion criteria was comparable with that reported by Irish et al. For cohorts excluded by Irish: (a) in pump-perfused kidneys, the IC overestimated DGF risk; (b) in simultaneous pancreas kidney transplants, the DGF risk was exceptionally low. For all 3 cohorts, there was considerable overlap in IC scores between those with and those without DGF. Using a modified definition of DGF-excluding those with single dialysis in the first 24 h posttransplant-we found that the calculator had similar performance as with the traditional DGF definition. Studying whether DGF prediction could be improved, we found that recipient cardiovascular disease was strongly associated with DGF even after accounting for IC-predicted risk. CONCLUSIONS The IC can be a useful population guide for predicting DGF in the population for which it was intended but has limited scope in expanded populations (SPK, pump) and for individual risk prediction. DGF risk prediction can be improved by inclusion of recipient cardiovascular disease.
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Affiliation(s)
- Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Erika Helgeson
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ann Fieberg
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Robert Leduc
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Robert S Gaston
- Department of Medicine, University of Alabama, Birmingham, AL
| | | | - David Rush
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Fernando Cosio
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph P Grande
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - J Michael Cecka
- Department of Pathology & Lab Medicine, David Geffen School of Medicine, University of California, UCLA Immunogenetics Center, Los Angeles, CA
| | - John Connett
- Biostatistics Division, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Roslyn B Mannon
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha, NE
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4
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Le Meur Y, Delpy E, Renard F, Hauet T, Badet L, Rerolle JP, Thierry A, Büchler M, Zal F, Barrou B. HEMO 2 life® improves renal function independent of cold ischemia time in kidney recipients: A comparison with a large multicenter prospective cohort study. Artif Organs 2021; 46:597-605. [PMID: 34951495 DOI: 10.1111/aor.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/23/2021] [Accepted: 12/02/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND M101 is an extracellular hemoglobin isolated from a marine lugworm and is present in the medical device HEMO2 life®. The clinical investigation OXYOP was a paired kidney analysis (n = 60) designed to evaluate the safety and performance of HEMO2 life® used as an additive to preservation solution in renal transplantation. The secondary efficacy endpoints showed less delayed graft function (DGF) and better renal function in the HEMO2 life® group but due to the study design cold ischemia time (CIT) was longer in the contralateral kidneys. METHODS An additional analysis was conducted including OXYOP patients and patients from the ASTRE database (n = 6584) to verify that the decrease in DGF rates observed in the HEMO2 life® group may not be due solely to the shorter CIT but also to HEMO2 life® performance. Kaplan-Meier estimate curves of cumulative probability of achieving a creatinine level below 250 µmol/L were generated and compared in both groups. A Cox model was used to test the effect of the explanatory variables (use of HEMO2 life® and CIT). Finally, a bootstrap strategy was used to randomly select smaller samples of patients and test them for statistical comparison in the ASTRE database. RESULTS Kaplan-Meier estimate curves confirmed the existence of a relation between DGF and CIT and Cox analysis showed a benefit in the HEMO2 life® group regardless of the associated CIT. Boostrap analysis confirmed these results. CONCLUSIONS The present study suggested that the better recovery of renal function observed among kidneys preserved with HEMO2 life® in the OXYOP study is a therapeutic benefit of this breakthrough innovative medical device.
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Affiliation(s)
- Yannick Le Meur
- Department of Nephrology, CHU de Brest, Brest, France.,UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO, Brest, France
| | - Eric Delpy
- HEMARINA, Aéropôle Centre, Morlaix, France
| | - Felix Renard
- Department of Nephrology, CHU de Brest, Brest, France
| | | | - Lionel Badet
- Department of Urology and Transplant Surgery, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | | | | | - Matthias Büchler
- Department of Nephrology and Clinical immunology, CHU de Tours, Tours, France
| | - Franck Zal
- HEMARINA, Aéropôle Centre, Morlaix, France
| | - Benoit Barrou
- Département D'urologie, Néphrologie et Transplantation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris AP-HP, Hôpitaux Universitaires PitiéSalpêtrière - Charles Foix, Paris, France
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5
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Schrezenmeier E, Müller M, Friedersdorff F, Khadzhynov D, Halleck F, Staeck O, Dürr M, Zhang K, Eckardt KU, Budde K, Lehner LJ. Evaluation of severity of delayed graft function in kidney transplant recipients. Nephrol Dial Transplant 2021; 37:973-981. [PMID: 34665258 DOI: 10.1093/ndt/gfab304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The most common definition of delayed graft function (DGF) relies on dialysis during the first week post-transplant and does not consider DGF severity. The impact of DGF severity on long-term graft outcome remains controversial. METHODS We analyzed 627 deceased-donor kidney transplant recipients (KTR) transplanted 2005-2015 at our center for DGF-severity, associated risk factors and long-term consequences of DGF. RESULTS We found 349 (55.7%) KTR with DGF, which were classified into 4 groups according to DGF duration (0-1, 2-7, 8-14, >14 days) and were compared to KTR with no DGF. Increasing duration of DGF was associated with progressive worsening of 10-year death-censored graft survival (no DGF: 88.3% (95%CI: 82.4-94.2), 0-1 day: 81.3% (95%CI: 68.2-94.4), 2-7 days: 61.5% (95%CI: 43.1.1-79.9), 8-14 days: 66.6% (95%CI: 47.4-85.8), >14 days: 51.2% (95%CI: 33-69.4); p < 0.001). In kidneys with a Kidney Donor Profile Index (KDPI) ≥85% all DGF severity groups demonstrated reduced graft survival. However, in < 85%KDPI kidneys, only > 14 days DGF duration showed worse outcomes. CONCLUSIONS DGF had a duration-dependent effect on graft survival, which varied depending on KDPI. Of note, 0-1-day DGF showed comparable results to no DGF in the whole cohort.
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Affiliation(s)
- Eva Schrezenmeier
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Mia Müller
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité Universitätsmedizin Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Dmytro Khadzhynov
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Staeck
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Dürr
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kun Zhang
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lukas J Lehner
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
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6
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Phillips BL, Ibrahim M, Greenhall GHB, Mumford L, Dorling A, Callaghan CJ. Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study. Am J Transplant 2021; 21:3346-3355. [PMID: 33756062 DOI: 10.1111/ajt.16574] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 01/25/2023]
Abstract
Kidneys from donation after circulatory death (DCD) donors are utilized variably worldwide, in part due to high rates of delayed graft function (DGF) and putative associations with adverse longer-term outcomes. We aimed to determine whether the presence of DGF and its duration were associated with poor longer-term outcomes after kidney transplantation from DCD donors. Using the UK transplant registry, we identified 4714 kidney-only transplants from controlled DCD donors to adult recipients between 2006 and 2016; 2832 recipients (60·1%) had immediate graft function and 1882 (39·9%) had DGF. Of the 1847 recipients with DGF duration recorded, 926 (50·1%) had DGF < 7 days, 576 (31·2%) had DGF 7-14 days, and 345 (18·7%) had DGF >14 days. After risk adjustment, the presence of DGF was not associated with inferior long-term graft or patient survivals. However, DGF duration of >14 days was associated with an increased risk of death-censored graft failure (hazard ratio 1·7, p = ·001) and recipient death (hazard ratio 1·8, p < ·001) compared to grafts with immediate function. This study suggests that shorter periods of DGF have no adverse influence on graft or patient survival after DCD donor kidney transplantation and that DGF >14 days is a novel early biomarker for significantly worse longer-term outcomes.
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Affiliation(s)
- Benedict L Phillips
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - George H B Greenhall
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.,Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Lisa Mumford
- Department of Statistics and Clinical Studies, National Health Service Blood and Transplant (NHSBT), Bristol, UK
| | - Anthony Dorling
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, London, UK
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7
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Hart A, Schladt DP, Matas AJ, Itzler R, Israni AK, Kasiske BL. Incidence, risk factors, and long-term outcomes associated with antibody-mediated rejection - The long-term Deterioration of Kidney Allograft Function (DeKAF) prospective cohort study. Clin Transplant 2021; 35:e14337. [PMID: 33955070 DOI: 10.1111/ctr.14337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 01/03/2023]
Abstract
Major gaps remain in our understanding of antibody-mediated rejection (AMR) after kidney transplant. We examined the incidence, risk factors, response to treatment, and effects on outcomes of AMR at seven transplant programs in the long-term Deterioration of Kidney Allograft Function prospective study cohort. Among 3131 kidney recipients, there were 194 observed AMR cases (6.2%) during (mean ± SD) 4.85 ± 1.86 years of follow-up. Time to AMR was 0.97 ± 1.17 (median, 0.48) years. Risk factors for AMR included younger recipient age, human leukocyte antigen DR mismatches, panel-reactive antibody >0%, positive T- or B-cell cross-match, and delayed graft function. Compared with no AMR, the adjusted time-dependent hazard ratio for death-censored graft failure is 10.1 (95% confidence interval, 6.5-15.7) for all AMR patients, 4.0 (2.5, 9.1) for early AMR (<90 days after transplant), and 24.0 (14.0-41.1) for late AMR (≥90 days after transplant). Patients were treated with different therapeutic combinations. Of 194 kidney transplant recipients with AMR, 50 (25.8%) did not respond to treatment, defined as second AMR within 100 days or no improvement in estimated glomerular filtration rate by 42 days. Long-term outcomes after AMR are poor, regardless of the initial response to treatment. Better prevention and new therapeutic strategies are needed to improve long-term allograft survival.
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Affiliation(s)
- Allyson Hart
- Department of Medicine, Hennepin County Medical Center, Hennepin Healthcare, Minneapolis, MN, USA.,Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - David P Schladt
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | | | - Ajay K Israni
- Department of Medicine, Hennepin County Medical Center, Hennepin Healthcare, Minneapolis, MN, USA.,Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Bertram L Kasiske
- Department of Medicine, Hennepin County Medical Center, Hennepin Healthcare, Minneapolis, MN, USA.,Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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8
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Jahn L, Rüster C, Schlosser M, Winkler Y, Foller S, Grimm MO, Wolf G, Busch M. Rate, Factors, and Outcome of Delayed Graft Function After Kidney Transplantation of Deceased Donors. Transplant Proc 2021; 53:1454-1461. [PMID: 33612277 DOI: 10.1016/j.transproceed.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/08/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Delayed graft function (DGF) is a frequent complication after kidney transplantation affecting long-term outcome. PATIENTS AND METHODS A total of 525 consecutive recipients (age 54.2 ± 13.4 years, 33% female) of kidneys from deceased donors transplanted between 2005 and 2012 were retrospectively examined. DGF was defined as the need of dialysis within the first week after transplantation. RESULTS DGF developed in 21.1% (n = 111). Factors associated with DGF (P ≤ .035, respectively) were recipient body mass index, C-reactive protein of the recipient, residual diuresis, cold ischemia time, donor age, and diuresis in the first hour after transplantation. Median duration of DGF was 16 (2-66) days. Patients after DGF had a significantly lower GFR compared with recipients without DGF either after 3 (32.9 ± 16.5 vs 46.3 ± 18.4 mL/min/1.73 m2) or after 12 months (38.9 ± 19.3 vs 48.6 ± 20.4 mL/min/1.73 m2, P < .001, resp.). During DGF, 12.4% developed BANFF II and 18.0% BANFF I rejection, 20.2% had signs of transplant glomerulitis (first biopsy), and 16.2% (n = 18) remained on dialysis. CONCLUSION DGF affects 1 out of 5 kidney transplants from deceased donors. Minimizing modifiable risk factors, in particular immunologic risk, may ameliorate the incidence and outcome of DGF. The outcome of DGF depends mainly on the diagnosis of any rejection and worsens upon detection of transplant glomerulitis and pronounced interstitial fibrosis and tubular atrophy (IFTA).
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Affiliation(s)
- Laura Jahn
- Department of Internal Medicine III/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Christiane Rüster
- Department of Internal Medicine III/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Mandy Schlosser
- Department of Internal Medicine III/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Yvonne Winkler
- Department of Urology/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Susan Foller
- Department of Urology/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Marc-Oliver Grimm
- Department of Urology/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Gunter Wolf
- Department of Internal Medicine III/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany
| | - Martin Busch
- Department of Internal Medicine III/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany.
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9
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Montagud-Marrahi E, Molina-Andújar A, Rovira J, Revuelta I, Ventura-Aguiar P, Piñeiro G, Ugalde-Altamirano J, Perna F, Torregrosa JV, Oppenheimer F, Esforzado N, Cofán F, Campistol JM, Herrera-Garcia A, Ríos J, Diekmann F, Cucchiari D. The impact of functional delayed graft function in the modern era of kidney transplantation - A retrospective study. Transpl Int 2020; 34:175-184. [PMID: 33131120 DOI: 10.1111/tri.13781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/10/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
The dialysis-based definition of Delayed Graft Function (dDGF) is not necessarily objective as it depends on the individual physician's decision. The functional definition of DGF (fDGF, the failure of serum creatinine to decrease by at least 10% daily on 3 consecutive days during the first week post-transplant), may be more sensitive to reflect recovery after the ischemia-reperfusion injury. We retrospectively analyzed both definitions in 253 deceased donor kidney transplant recipients for predicting death-censored graft failure as primary outcome, using eGFR < 25 ml/min/1.73 m2 as a surrogate end-point for graft failure. Secondary outcome was a composite outcome that included graft failure as above and also patient's death. Median follow-up was 3.22 [2.38-4.21] years. Seventy-nine patients developed dDGF (31.2%) and 127 developed fDGF (50.2%). Sixty-three patients fulfilled criteria for both definitions (24.9%). At multivariable analysis, the two definitions were significantly associated with the primary [HR (95%CI) 2.07 (1.09-3.94), P = 0.026 for fDGF and HR (95%CI) 2.41 (1.33-4.37), P = 0.004 for dDGF] and the secondary composite outcome [HR (95%CI) 1.58 (1.01-2.51), P = 0.047 for fDGF and HR (95%CI) 1.67 (1.05-2.66), P = 0.028 for dDGF]. Patients who met criteria for both definitions had the worst prognosis, with a three-year estimates (95%CI) of survival from the primary and secondary outcomes of 2.31 (2.02-2.59) and 2.20 (1.91-2.49) years for fDGF+/dDGF+, in comparison with the other groups (P < 0.01 for trend). fDGF provides supplementary information about graft outcomes on top of the dDGF definition in a modern series of kidney transplantation.
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Affiliation(s)
| | | | - Jordi Rovira
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Revuelta
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Gastón Piñeiro
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain
| | | | - Francesco Perna
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain
| | | | | | - Nuria Esforzado
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain
| | - Frederic Cofán
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Jose Ríos
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Red de Investigación Renal (REDINREN), Instituto de Salud Carlos III, Madrid, Spain
| | - David Cucchiari
- Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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10
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Meister FA, Czigany Z, Rietzler K, Miller H, Reichelt S, Liu WJ, Boecker J, Moeller MJ, Tolba RH, Hamesch K, Strnad P, Boor P, Stoppe C, Neumann UP, Lurje G. Decrease of renal resistance during hypothermic oxygenated machine perfusion is associated with early allograft function in extended criteria donation kidney transplantation. Sci Rep 2020; 10:17726. [PMID: 33082420 PMCID: PMC7575556 DOI: 10.1038/s41598-020-74839-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/30/2020] [Indexed: 12/19/2022] Open
Abstract
Hypothermic oxygenated machine perfusion (HOPE) was recently tested in preclinical trials in kidney transplantation (KT). Here we investigate the effects of HOPE on extended-criteria-donation (ECD) kidney allografts (KA). Fifteen ECD-KA were submitted to 152 ± 92 min of end-ischemic HOPE and were compared to a matched group undergoing conventional-cold-storage (CCS) KT (n = 30). Primary (delayed graft function-DGF) and secondary (e.g. postoperative complications, perfusion parameters) endpoints were analyzed within 6-months follow-up. There was no difference in the development of DGF between the HOPE and CCS groups (53% vs. 33%, respectively; p = 0.197). Serum urea was lower following HOPE compared to CCS (p = 0.003), whereas the CCS group displayed lower serum creatinine and higher eGFR rates on postoperative days (POD) 7 and 14. The relative decrease of renal vascular resistance (RR) following HOPE showed a significant inverse association with serum creatinine on POD1 (r = − 0.682; p = 0.006) as well as with serum urea and eGFR. Besides, the relative RR decrease was more prominent in KA with primary function when compared to KA with DGF (p = 0.013). Here we provide clinical evidence on HOPE in ECD-KT after brain death donation. Relative RR may be a useful predictive marker for KA function. Further validation in randomized controlled trials is warranted. Trial registration: clinicaltrials.gov (NCT03378817, Date of first registration: 20/12/2017).
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Affiliation(s)
- Franziska A Meister
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Katharina Rietzler
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Hannah Miller
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Sophie Reichelt
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Wen-Jia Liu
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Joerg Boecker
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcus J Moeller
- Division of Nephrology, Department of Medicine II, University Hospital RWTH Aachen, Aachen, Germany
| | - Rene H Tolba
- Institute for Laboratory Animal Science and Experimental Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Karim Hamesch
- Division of Gastroenterology and Hepatology, Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Pavel Strnad
- Division of Gastroenterology and Hepatology, Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Stoppe
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany. .,Department of Surgery, Chirugische Klinik, Campus Charité Mitte
- Campus Virchow Klinikum-Charité Universitätsmedizin Berlin, Berlin, Germany.
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11
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Arias-Cabrales CE, Pérez-Sáez MJ, Redondo-Pachón D, Buxeda A, Burballa C, Duran X, Mir M, Crespo M, Pascual J. Relevance of KDPI value and acute rejection on kidney transplant outcomes in recipients with delayed graft function - a retrospective study. Transpl Int 2020; 33:1071-1077. [PMID: 32418259 DOI: 10.1111/tri.13654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/20/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
Delayed graft function (DGF) is associated with poorer graft survival and higher rate of acute rejection (AR). It is unknown whether this negative influence relies on the increased risk of AR or the DGF itself. The different Kidney Donor Profile Index (KDPI) values may also play a role in this interaction. Retrospective study aimed to evaluate the impact of DGF on graft function and graft survival in a subset of KT recipients (2004-2017). We also analyzed the relationship between KDPI and DGF. The study includes 601 KT, 226 of them (37%) developed DGF. Graft survival was lower in patients with DGF compared with non-DGF patients. Multivariable analysis revealed DGF as risk factor for graft loss, independently of the presence or not of acute rejection. Between DGF patients, we observed poorer graft survival in patients with higher KDPI value (>85%). We observed a trend of a greater impact of KDPI in patients with DGF, although this interaction was not statistically significant. Additionally, we observed poorer 12-month graft function in DGF patients. DGF is related to poorer graft survival independently of the developed acute rejection. This negative impact might be influenced by high KDPI values.
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Affiliation(s)
| | | | | | - Anna Buxeda
- Nephrology, Hospital del Mar, Barcelona, Spain
| | | | - Xavier Duran
- Methodological and Biostatistics consultancy, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Marisa Mir
- Nephrology, Hospital del Mar, Barcelona, Spain
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12
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Le Meur Y, Badet L, Essig M, Thierry A, Büchler M, Drouin S, Deruelle C, Morelon E, Pesteil F, Delpech PO, Boutin JM, Renard F, Barrou B. First-in-human use of a marine oxygen carrier (M101) for organ preservation: A safety and proof-of-principle study. Am J Transplant 2020; 20:1729-1738. [PMID: 32012441 DOI: 10.1111/ajt.15798] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/02/2020] [Accepted: 01/15/2020] [Indexed: 01/25/2023]
Abstract
The medical device M101 is an extracellular hemoglobin featuring high oxygen-carrying capabilities. Preclinical studies demonstrated its safety as an additive to organ preservation solutions and its beneficial effect on ischemia/reperfusion injuries. OXYgen carrier for Organ Preservation (OXYOP) is a multicenter open-label study evaluating for the first time the safety of M101 added (1 g/L) to the preservation solution of one of two kidneys from the same donor. All adverse events (AEs) were analyzed by an independent data and safety monitoring board. Among the 58 donors, 38% were extended criteria donors. Grafts were preserved in cold storage (64%) or machine perfusion (36%) with a mean cold ischemia time (CIT) of 740 minutes. At 3 months, 490 AEs (41 serious) were reported, including two graft losses and two acute rejections (3.4%). No immunological, allergic, or prothrombotic effects were reported. Preimplantation and 3-month biopsies did not show thrombosis or altered microcirculation. Secondary efficacy end points showed less delayed graft function (DGF) and better renal function in the M101 group than in the contralateral kidneys. In the subgroup of grafts preserved in cold storage, Kaplan-Meier survival and Cox regression analysis showed beneficial effects on DGF independent of CIT (P = .048). This study confirms that M101 is safe and shows promising efficacy data.
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Affiliation(s)
- Yannick Le Meur
- Department of Nephrology, CHU de Brest, Brest, France.,UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, Labex IGO, Brest, France
| | - Lionel Badet
- Department of Urology and Transplant Surgery, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marie Essig
- Department of Nephrology and Renal Transplantation, CHU de Limoges, Limoges, France
| | | | - Matthias Büchler
- Department of Nephrology and Clinical immunology, CHU de Tours, Tours, France
| | - Sarah Drouin
- Département D'urologie, Néphrologie et Transplantation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | | | - Emmanuel Morelon
- Department of Transplantation, Nephrology and Clinical Immunology, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Francis Pesteil
- Department of Vascular Surgery, CHU de Limoges, Limoges, France
| | | | | | - Felix Renard
- Department of Nephrology, CHU de Brest, Brest, France
| | - Benoit Barrou
- Département D'urologie, Néphrologie et Transplantation, Sorbonne Université, Assistance Publique - Hôpitaux de Paris AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
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13
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Okada K, Nomura-Nakayama K, Okushi Y, Okino K, Mukai K, Hayashi N, Fujimoto K, Adachi H, Yokoyama H. Changes in double-strand DNA breaks predict delayed graft function (DGF) in Japanese renal allograft recipients. Clin Exp Nephrol 2019; 24:96-104. [PMID: 31811409 DOI: 10.1007/s10157-019-01793-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although delayed graft function (DGF) is a serious complication following kidney transplantation, a reliable and early diagnostic test is lacking to identify the grade of DGF. METHODS We investigated changes in double-strand DNA breaks (DSBs), and factors related to DGF, such as ischemic times at transplantation and serum creatinine (sCr) levels. DSBs were detected by phospho-histone H2A.X (γ-H2AX) expression and cellular regeneration by Ki-67 before (0 h) and 1 h after allograft reperfusion (1 h) in each subject. RESULTS The expression of γ-H2AX or Ki-67 at 0 h showed no difference between the living and deceased donors. γ-H2AX at 1 h decreased in the living donors, but increased in the deceased donors compared with that of 0 h(p = 0.017). Changes (Δ) in γ-H2AX between 0 and 1 h were different among subgroups, i.e., immediate function, slow graft function with dialysis < 7 days, DGF with dialysis < 4 weeks, severe DGF with dialysis > 4 weeks, or primary non-function (PNF) (p = 0.04). Severe DGF and PNF cases showed greater increase in Δγ-H2AX (p = 0.019), and were distinguished by > 12% of Δγ-H2AX at 100% sensitivity and 88.2% specificity (ROC analysis, AUC: 0.922, p = 0.023). In a multivariate regression analysis, donor sCr and Δγ-H2AX were two main predictors of the grade of DGF (p = 0.002). The expression of Ki-67 was very low at both 0 h and 1 h. CONCLUSION The combination of donor sCr and Δγ-H2AX from 0 to 1 h after reperfusion may predict severe DGF and PNF in the early phase.
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Affiliation(s)
- Keiichiro Okada
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Kanae Nomura-Nakayama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Yuki Okushi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Kazuaki Okino
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Kiyotaka Mukai
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Norifumi Hayashi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Keiji Fujimoto
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hiroki Adachi
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
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14
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Intraoperative Fluid Restriction is Associated with Functional Delayed Graft Function in Living Donor Kidney Transplantation: A Retrospective Cohort Analysis. J Clin Med 2019; 8:jcm8101587. [PMID: 31581669 PMCID: PMC6832291 DOI: 10.3390/jcm8101587] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background: In 2016 we observed a marked increase in functional delayed graft function (fDGF) in our living donor kidney transplantation (LDKT) recipients from 8.5% in 2014 and 8.8% in 2015 to 23.0% in 2016. This increase coincided with the introduction of a goal-directed fluid therapy (GDFT) protocol in our kidney transplant recipients. Hereupon, we changed our intraoperative fluid regimen to a fixed amount of 50 mL/kg body weight (BW) and questioned whether the intraoperative fluid regimen was related to this increase in fDGF. Methods: a retrospective cohort analysis of all donors and recipients in our LDKT program between January 2014–February 2017 (n = 275 pairs). Results: Univariate analysis detected various risk factors for fDGF. Dialysis dependent recipients were more likely to develop fDGF compared to pre-emptively transplanted patients (p < 0.001). Recipients developing fDGF received less intraoperative fluid (36 (25.9–50.0) mL/kg BW vs. 47 (37.3–55.6) mL/kg BW (p = 0.007)). The GDFT protocol resulted in a reduction of intraoperative fluid administration on average by 850 mL in total volume and 21% in mL/kg BW compared to our old protocol (p < 0.001). In the unadjusted analysis, a higher intraoperative fluid volume in mL/kg BW was associated with a lower risk for the developing fDGF (OR 0.967, CI (0.941–0.993)). After adjustment for the confounders, prior dialysis and the use of intraoperative noradrenaline, the relationship of fDGF with fluid volume was still apparent (OR 0.970, CI (0.943–0.998)). Conclusion: Implementation of a GDFT protocol led to reduced intraoperative fluid administration in the LDKT recipients. This intraoperative fluid restriction was associated with the development of fDGF.
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15
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Lee CH, Gwon JG, Jung CW. Effectiveness of Thymoglobulin Induction Therapy in Kidney Transplant From Deceased Donor With Mild to Moderate Acute Kidney Injury. Transplant Proc 2019; 51:2611-2614. [PMID: 31474447 DOI: 10.1016/j.transproceed.2019.02.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The clinical benefit of rabbit antithymocyte globulin (Thymoglobulin) compared with basiliximab for induction therapy in kidney transplant (KT) resulting from acute kidney injury (AKI) donors remains controversial. In cases of severe AKI, the degree of kidney injury is too great to reveal influence of different induction therapies on clinical outcomes. We aimed to compare clinical outcomes of Thymoglobulin and basiliximab induction therapy in KTs from deceased donors (DDs) with mild to moderate AKI. METHODS We retrospectively studied 147 patients who received KTs from DDs between 2009 and 2017 in our center; 91 patients received kidneys from AKI donors. The AKI severity was classified based on the Acute Kidney Injury Network (AKIN) staging, and patients with AKIN stage 3 (43 patients) were excluded. Clinical outcomes were compared according to the type of induction therapy. RESULTS Thymoglobulin and basiliximab induction groups showed no significant differences in demographic and baseline characteristics except donor age and follow-up period. The Thymoglobulin group had lower incidences of acute rejection and a trend toward a lower incidence of delayed graft function and better graft survival than the basiliximab group. There was no significant difference in BK infection rate; however, cytomegalovirus infection rate showed a trend toward a lower incidence in the basiliximab group. CONCLUSIONS In cases of KT from AKIN stage 1 and 2 donors, Thymoglobulin showed better clinical outcomes than basiliximab, although it had a somewhat high rate of cytomegalovirus infection. It seems beneficial to use Thymoglobulin induction therapy in KTs from DDs with mild to moderate AKI.
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Affiliation(s)
- Chang Hun Lee
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jun Gyo Gwon
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, Korea
| | - Cheol Woong Jung
- Department of Transplantation and Vascular Surgery, Korea University College of Medicine, Seoul, Korea.
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16
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Shamali A, Kassimatis T, Phillips BL, Burton H, Kessaris N, Callaghan C. Duration of delayed graft function and outcomes after kidney transplantation from controlled donation after circulatory death donors: a retrospective study. Transpl Int 2019; 32:635-645. [PMID: 30685880 DOI: 10.1111/tri.13403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/24/2018] [Accepted: 01/21/2019] [Indexed: 11/26/2022]
Abstract
The impact of the duration of delayed graft function (DGF) on graft survival is poorly characterized in controlled donation after circulatory death (DCD) donor kidney transplantation. A retrospective analysis was performed on 225 DCD donor kidney transplants between 2011 and 2016. When patients with primary nonfunction were excluded (n = 9), 141 recipients (65%) had DGF, with median (IQR) duration of dialysis dependency of 6 (2-11.75) days. Longer duration of dialysis dependency was associated with lower estimated glomerular filtration rate at 1 year, and a higher rate of acute rejection. On Kaplan-Meier analysis, the presence of DGF was associated with lower graft survival (log-rank test P = 0.034), though duration of DGF was not (P = 0.723). However, multivariable Cox regression analysis found that only acute rejection was independently associated with lower graft survival [HR (95% CI) 4.302 (1.617-11.450); P = 0.003], whereas the presence of DGF and DGF duration were not. In controlled DCD kidney transplantation, DGF duration itself may not be independently associated with graft survival; rather, it may be that acute rejection associated with prolonged DGF is the poor prognostic factor.
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Affiliation(s)
- Awad Shamali
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Theodoros Kassimatis
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benedict L Phillips
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hannah Burton
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicos Kessaris
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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17
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Quintella AHDS, Lasmar MF, Fabreti-Oliveira RA, Nascimento E. Delayed Graft Function, Predictive Factors, and 7-Year Outcome of Deceased Donor Kidney Transplant Recipients With Different Immunologic Profiles. Transplant Proc 2018; 50:737-742. [PMID: 29661426 DOI: 10.1016/j.transproceed.2018.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Delayed graft function (DGF) is the major post-transplant cause of deleterious effects to the allograft and is associated with poor allograft survival. The aim of this study was to report the outcomes of 236 kidney transplant recipients with different immunologic profiles. METHODS All patients underwent transplantation (2008-2016) with a deceased donor at the University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil. Patients were classified into 3 groups according to immunologic profiles: nonsensitized (NS), sensitized without donor-specific antibody (SDSA-), or sensitized with donor-specific antibody (SDSA+). RESULTS DGF was observed in 128 (54.24%), including 63 (49.22%) NS, 51 (39.84%) SDSA-, and 14 (10.94%) SDSA+ patients. The development of DGF was associated with dialysis for ≥49.25 months (odds ratio [OR] 2.30), donor age ≥42.25 years (OR 1.77), donor end creatinine level >1.22 mg/dL (OR 1.94), and cold ischemia time >12 hours (OR 2.45). Of the 55 patients with rejections, 37 (15.68%) had T-cell-mediated rejection (TCMR) and 18 (7.63%) had antibody-mediated rejection (AMR). Nine patients (16.36%) exhibited graft loss, 2 (0.85%) via TCMR in the SDSA- DGF+ group and 7 (2.97%) via AMR, including 2 NS DGF-, 2 SDSA- DGF-, 1 SDSA- DGF+, and 2 SDSA+ DGF+ patients. Graft survival significantly differed between the NSDGF- and SDSA- DGF+ groups (P = .014) and between the NS DGF- and SDSA+ DGF- groups (P = .036). CONCLUSION In the 7-year period following transplantation, TCMR was more prevalent than AMR among patients with DGF. Graft loss was less prevalent among patients with TCMR than among those with AMR.
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Affiliation(s)
- A H D S Quintella
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - M F Lasmar
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - R A Fabreti-Oliveira
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Histocompatibility Laboratory, Belo Horizonte, Minas Gerais, Brazil
| | - E Nascimento
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB-Histocompatibility Laboratory, Belo Horizonte, Minas Gerais, Brazil.
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18
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Weber S, Dienemann T, Jacobi J, Eckardt KU, Weidemann A. Delayed graft function is associated with an increased rate of renal allograft rejection: A retrospective single center analysis. PLoS One 2018; 13:e0199445. [PMID: 29928026 PMCID: PMC6013231 DOI: 10.1371/journal.pone.0199445] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 06/07/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The association of delayed graft function (DGF) and biopsy proven acute rejection (BPAR) of renal allografts is controversial. Borderline rejections comprise a major portion of biopsy results but the significance of such histologic changes is debated. The present study explores the impact of DGF on BPAR with a special emphasis on discriminating the effects of borderline rejection. METHODS Single center analysis of 417 deceased donor kidney recipients (age>18; transplantation date 1/2008-2/2015). Patients with primary non-function were excluded. DGF was defined as the need for dialysis within the first week after transplantation. Acute rejection was defined according to Banff criteria. Cox proportional hazards models were used to examine the relationship of DGF with BPAR within the first year. RESULTS No graft loss was observed during the first year after transplantation. DGF significantly associated with BPAR in the first year, irrespective of whether borderline rejections were included (HR 1.71, 95%CI 1.16,2.53) or excluded (HR 1.79, 95%CI 1.13,2.84). CONCLUSION DGF is significantly associated with rejection-with or without borderline changes-within the first year.
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Affiliation(s)
- Susanne Weber
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Thomas Dienemann
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- * E-mail:
| | - Johannes Jacobi
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Kai-Uwe Eckardt
- Medizinische Klinik, Nephrologie und Internistische Intensivmedizin, Charite, Berlin, Germany
| | - Alexander Weidemann
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Medizinische Klinik 1, Nephrologie, Transplantation und internistische Intensivmedizin, Krankenhaus Köln Merheim, Klinikum der Universität Witten-Herdecke, Cologne, Germany
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19
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Incerti D, Summers N, Ton TGN, Boscoe A, Chandraker A, Stevens W. The Lifetime Health Burden of Delayed Graft Function in Kidney Transplant Recipients in the United States. MDM Policy Pract 2018; 3:2381468318781811. [PMID: 30288451 PMCID: PMC6124921 DOI: 10.1177/2381468318781811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background. Although delayed graft function (DGF) is associated with
an increased risk of acute rejection and decreased graft survival, there are no
estimates of the long-term or lifetime health burden of DGF.
Objectives. To estimate the long-term and lifetime health
burden of DGF, defined as the need for at least one dialysis session within the
first week after transplantation, for a cohort representative of patients who
had their first kidney transplant in 2014. Methods. Data from the
United States Renal Data System (USRDS; 2001–2014) were used to estimate a
semi-Markov parametric multi-state model with three disease states. Maximum
length of follow-up was 13.7 years, and a microsimulation model was used to
extrapolate results over a lifetime. The impact of DGF was assessed by
simulating the model for each patient in the cohort with and without DGF.
Results. At the end of 13.7 years of follow-up, DGF reduces the
probability of having a functioning graft from 52% to 32%, increases the
probability of being on dialysis from 10% to 19%, and increases the probability
of death from 38% to 50% relative to transplant recipients who do not experience
DGF. A typical transplant recipient with DGF (median age = 53) is observed to
lose 0.87 quality-adjusted life-years (QALYs). Extrapolated over a lifetime, the
same 53-year-old DGF patient is projected to lose 3.01 (95% confidence interval:
2.33, 3.70) QALYs relative to a transplant recipient with the same
characteristics who does not experience DGF. Conclusions. The
lifetime health burden of DGF is substantial. Understanding these consequences
will help health care providers weigh kidney transplant decisions and inform
policies for patients in the context of varying risks of DGF.
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Affiliation(s)
| | | | | | - Audra Boscoe
- Alexion Pharmaceuticals Inc., New Haven, Connecticut
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Cardiac output-based fluid optimization for kidney transplant recipients: a proof-of-concept trial. Can J Anaesth 2018; 65:873-883. [PMID: 29637407 DOI: 10.1007/s12630-018-1118-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Intravenous fluid management for deceased donor kidney transplantation is an important, modifiable risk factor for delayed graft function (DGF). The primary objective of this study was to determine if goal-directed fluid therapy using esophageal Doppler monitoring (EDM) to optimize stroke volume (SV) would alter the amount of fluid given. METHODS This randomized, proof-of-concept trial enrolled 50 deceased donor renal transplant recipients. Data collected included patient characteristics, fluid administration, hemodynamics, and complications. The EDM was used to optimize SV in the EDM group. In the control group, fluid management followed the current standard of practice. The groups were compared for the primary outcome of total intraoperative fluid administered. RESULTS There was no difference in the mean (standard deviation) volume of intraoperative fluid administered to the 24 control and 26 EDM patients [2,307 (750) mL vs 2,675 (842) mL, respectively; mean difference, 368 mL; 95% confidence interval (CI), - 87 to + 823; P = 0.11]. The incidence of complications in the control and EDM groups was similar (15/24 vs 17/26, respectively; P = 0.99), as was the incidence of delayed graft failure (8/24 vs 11/26, respectively; P = 0.36). CONCLUSIONS Goal-directed fluid therapy did not alter the volume of fluid administered or the incidence of complications. This proof-of-concept trial provides needed data for conducting a larger trial to determine the influence of fluid therapy on the incidence in DGF in deceased donor kidney transplantation. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02512731). Registered 31 July 2015.
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21
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Wang CJ, Tuffaha A, Phadnis MA, Mahnken JD, Wetmore JB. Association of Slow Graft Function with Long-Term Outcomes in Kidney Transplant Recipients. Ann Transplant 2018. [PMID: 29610451 PMCID: PMC6248282 DOI: 10.12659/aot.907397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Whether slow graft function (SGF) represents an intermediate phenotype between immediate graft function (IGF) and delayed graft function (DGF) in kidney transplant recipients is unknown. Material/Methods In a retrospective cohort analysis of 1,222 kidney transplant recipients, we classified patients as having IGF, SGF, and DGF using two different schemas. SGF was defined as serum creatinine (Cr) ≥3.0 mg/dL by postoperative day 5 in Schema 1, and in Schema 2, SGF was defined as Cr >1.5 mg/dL plus a creatinine reduction ratio <20% between postoperative days 1 and 3. A complementary log-log model was used to examine the association of graft function with graft survival and patient survival. Results Mean age of study patients was 51.5±13.3 years, 59.9% were male, and 66.7% were white. In Schema 1, SGF and DGF were associated with comparable increases in risk of graft failure compared to IGF (hazard ratio (HR) 1.46, 95% confidence intervals (CI) 1.02–2.10 for SGF and HR 1.56, CI 1.11–2.22 for IGF); estimates were similar for Schema 2 (HR 1.52, CI 1.05–2.20 for SGF and HR 1.54, CI 1.10–2.17 for IGF). However, for mortality, outcomes for SGF were similarly to IGF, both SGF and IGF were associated with lower risk relative to DGF (HR 0.54, CI 0.36–0.80 for SGF in Schema 1; HR 0.58, CI 0.39–0.85 for SGF in Schema 2). Conclusions These findings suggest that SGF may be a marker for graft failure but not for mortality, and SGF may therefore represent a phenotype separate from IGF and DGF.
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Affiliation(s)
- Connie J Wang
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Ahmad Tuffaha
- Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas City, KS, USA.,The Kidney Institute, University of Kansas Medical Center, Kansas City, KS, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - James B Wetmore
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA.,Chronic Disease Research Group, Minneapolis, MN, USA
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22
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Abstract
BACKGROUND Ischemia-reperfusion injury (IRI) leading to delayed graft function (DGF), defined by the United Network for Organ Sharing as dialysis in the first week (UNOS-DGF), associates with poor kidney transplant outcomes. Controversies remain, however, about dialysis initiation thresholds and the utility for other criteria to denote less severe IRI, or slow graft function (SGF). METHODS Multicenter, prospective study of deceased-donor kidney recipients to compare UNOS-DGF to a definition that combines impaired creatinine reduction in the first 48 hours or greater than 1 dialysis session for predicting 12-month estimated glomerular filtration rate (eGFR). We also assessed 10 creatinine and urine output-based SGF definitions relative to 12-month eGFR. RESULTS In 560 recipients, 215 (38%) had UNOS-DGF, 330 (59%) met the combined definition, 14 (3%) died, and 23 (4%) had death-censored graft failure by 12 months. Both DGF definitions were associated with lower adjusted 12-month eGFR (95% confidence interval)-by 7.3 (3.6-10.9) and 7.4 (3.8-11.0) mL/min per 1.73 m, respectively. Adjusted relative risks for 12-month eGFR less than 30 mL/min per 1.73 m were 1.9 (1.2-3.1) and 2.1 (1.1-3.7), with unadjusted areas under the curve of 0.618 and 0.627, respectively. For SGF definitions, postoperative day (POD) 7 creatinine had the strongest association with 12-month eGFR, and POD5 creatinine and creatinine reduction between POD1 and POD2 demonstrated modest separations in 12-month eGFR. CONCLUSIONS Although UNOS-DGF does not adequately predict 12-month function on its own, our findings do not support changing the definition. Postoperative day 7 creatinine is correlated with 12-month eGFR, but large translational studies are needed to understand the biological link between IRI severity at transplant and longer-term outcomes.
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23
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Cho K, Min SI, Ahn S, Min SK, Ahn C, Yu KS, Jang IJ, Cho JY, Ha J. Integrative Analysis of Renal Ischemia/Reperfusion Injury and Remote Ischemic Preconditioning in Mice. J Proteome Res 2017. [PMID: 28627174 DOI: 10.1021/acs.jproteome.7b00167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Remote ischemic preconditioning (RIPC) is a strategy to induce resistance in a target organ against the oxidative stress and injury caused by ischemia and reperfusion (IR). RIPC harnesses the body's endogenous protective capabilities through brief episodes of IR applied in organs remote from the target. Few studies have analyzed this phenomenon in the kidney. Furthermore, the window of protection representing RIPC efficacy has not been fully elucidated. Here, we performed a multiomics study to specify those associated with protective effects of RIPC against the IR injury. A total of 30 mice were divided to four groups: sham, IR only, late RIPC + IR, and early RIPC + IR. We found that IR clearly led to tubular injury, whereas both preconditioning groups exhibited attenuated injury after the insult. In addition, renal IR injury produced changes of the metabolome in kidney, serum, and urine specimens. Furthermore, distinctive mRNA and associated protein expression changes supported potential mechanisms. Our findings revealed that RIPC effectively reduces renal damage after IR and that the potential mechanisms differed between the two time windows of protection. These results may potentially be extended to humans to allow non- or minimally invasive diagnosis of renal IR injury and RIPC efficacy.
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Affiliation(s)
- Kumsun Cho
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine , Seoul 03080, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital , Seoul 03080, Republic of Korea
| | - Sang-Il Min
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine , Seoul 03080, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine , Seoul 03080, Republic of Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine , Seoul 03080, Republic of Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine , Seoul 03080, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine , Seoul 03080, Republic of Korea
| | - Kyung-Sang Yu
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine , Seoul 03080, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital , Seoul 03080, Republic of Korea
| | - In-Jin Jang
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine , Seoul 03080, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital , Seoul 03080, Republic of Korea
| | - Joo-Youn Cho
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine , Seoul 03080, Republic of Korea.,Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital , Seoul 03080, Republic of Korea
| | - Jongwon Ha
- Metabolomics Medical Research Center (MMRC), Seoul National University College of Medicine , Seoul 03080, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine , Seoul 03080, Republic of Korea
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24
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Impact and Application of Donor/Recipient Body Surface Area on Kidney Transplantation from Pediatric Donor to Adult Recipient. Transplant Proc 2017; 48:3274-3278. [PMID: 27931568 DOI: 10.1016/j.transproceed.2016.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/05/2016] [Accepted: 09/14/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Insufficient nephron dosing is closely associated with poor graft function and graft loss. Donor/recipient body surface area (D/R BSA) has been proven to be one of the useful predictors for sufficient nephron dosing. However, little is known regarding the impact and application of D/R BSA on kidney transplantation from pediatric donor to adult recipient. METHODS We retrospectively analyzed 26 cases of kidney transplantations from pediatric donors to adult recipients, which were performed in our center from 2010 through 2014. Patients were divided into 2 groups based on D/R BSA: group A, <0.8; and group B, ≥0.8. All recipients received a single kidney. Demographics of donors and recipients, early postoperative complications, estimated glomerular filtration rate (eGFR), and short-term (≤1 y) graft survival were compared between groups to evaluate the impact of D/R BSA on kidney transplantations from pediatric donors. RESULTS All demographics and early postoperative complications of group A were similar to those of group B (P > .05). eGFR in group A and group B at 1, 3, 6, and 12 months after transplantation were: 63.2 ± 5.0 vs 74.0 ± 7.6 (P = .008), 66.2 ± 4.9 vs 75.8 ± 5.9 (P = .004), 69.0 ± 4.8 vs 79.0 ± 6.3 (P = .004), and 69.4 ± 7.9 vs 79.2 ± 8.4 (P = .033). Short-term graft survival of group A was inferior to that of group B (62.5% vs 94.4%; P = .042). CONCLUSIONS We conclude that recipients with high D/R BSA are more likely to have better graft function. It is possible to make optimal allocation of pediatric donor kidneys on the basis of D/R BSA ≥0.8.
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25
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Jun H, Jung CW, Lim S, Kim MG. Kidney Donor Risk Index as the Predictor for the Short-term Clinical Outcomes After Kidney Transplant From Deceased Donor With Acute Kidney Injury. Transplant Proc 2017; 49:88-91. [PMID: 28104166 DOI: 10.1016/j.transproceed.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Kidney Donor Risk Index (KDRI) scoring system for deceased donors has been widely introduced for postoperative evaluation of graft function. We analyzed the usefulness of the KDRI in deceased donors with acute kidney injury (AKI). METHODS Forty-nine recipients from deceased donors with AKI between January 2009 and December 2014 were reviewed retrospectively. Data collected from donor medical records included age, height, weight, hypertension or diabetes history, cause of death, serum creatinine (sCr), and donation after cardiac death. Graft function data including sCr, estimated glomerular filtration rate (eGFR), and acute rejection episodes were monitored for 1 year. Correlations between KDRI score and factors indicating graft function were analyzed. A cutoff value for KDRI score was calculated using a receiver operating characteristic (ROC) curve for significant graft function. RESULTS The mean ages of donors and recipients were 46.81 ± 13.13 and 47.69 ± 11.43, respectively. The mean KDRI score was 1.24 ± 0.40. Univariable analysis of KDRI score and factors indicating graft function indicated that sCr at 6 to 12 months, eGFR at 1 year, and slow graft function (SGF) had statistical significance. The ROC curve of KDRI score for SGF showed an optimal cutoff value of 1.20, with sensitivity of 69.2% and specificity of 69.4% (area under the curve = 0.75) in deceased donors with AKI. CONCLUSIONS KDRI score in deceased donors with AKI was correlated with postoperative graft values including eGFR and SGF. KDRI could be used as a predictor for the short-term clinical outcome after kidney transplant from deceased donor with AKI.
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Affiliation(s)
- H Jun
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - C W Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea.
| | - S Lim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - M G Kim
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
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26
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Does Delayed Graft Function Still Herald a Poorer Outcome in Kidney Transplantation? CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0110-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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The impact of slow graft function on graft outcome is comparable to delayed graft function in deceased donor kidney transplantation. Int Urol Nephrol 2015; 48:431-9. [DOI: 10.1007/s11255-015-1163-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/09/2015] [Indexed: 01/30/2023]
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28
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Klotz S, Pallavi P, Tsagogiorgas C, Zimmer F, Zöllner FG, Binzen U, Greffrath W, Treede RD, Walter J, Harmsen MC, Krämer BK, Hafner M, Yard BA, Hoeger S. N-octanoyl dopamine treatment exerts renoprotective properties in acute kidney injury but not in renal allograft recipients. Nephrol Dial Transplant 2015; 31:564-73. [DOI: 10.1093/ndt/gfv363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 09/17/2015] [Indexed: 12/26/2022] Open
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29
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Chaumont M, Racapé J, Broeders N, El Mountahi F, Massart A, Baudoux T, Hougardy JM, Mikhalsky D, Hamade A, Le Moine A, Abramowicz D, Vereerstraeten P. Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome. J Transplant 2015; 2015:163757. [PMID: 26448870 PMCID: PMC4581567 DOI: 10.1155/2015/163757] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/26/2015] [Indexed: 01/10/2023] Open
Abstract
Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient's perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2-2.9]). Moreover, we observed two novel risk factors for DGF: patient's residual diuresis ≤500 mL/d (OR = 2.3 [1.6-3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0-5.4]). Area under the curve of the ROC curve (0.77 [0.74-0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival (P = 0.54). However, graft survival is decreased only when rejection was associated with DGF (P < 0.001). Conclusions. Perioperative saline loading efficiently prevents ischemia-reperfusion injury, which is the predominant factor inducing DGF. DGF per se has no influence on patient and graft outcome. Its incidence is currently close to 5% in our centre.
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Affiliation(s)
- Martin Chaumont
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Judith Racapé
- Research Center of Biostatistics, Epidemiology and Clinical Research, School of Public Health, Route de Lennik 808, 1070 Brussels, Belgium
| | - Nilufer Broeders
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Fadoua El Mountahi
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Annick Massart
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Thomas Baudoux
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Jean-Michel Hougardy
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Dimitri Mikhalsky
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Anwar Hamade
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Alain Le Moine
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Daniel Abramowicz
- Nephrology Department, Antwerp University Hospital, Free University of Brussels, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Pierre Vereerstraeten
- Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium
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30
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Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int 2015; 88:851-8. [PMID: 26108067 DOI: 10.1038/ki.2015.190] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 04/09/2015] [Accepted: 04/23/2015] [Indexed: 01/19/2023]
Abstract
Delayed graft function (DGF) is commonly considered a risk factor for acute rejection, although this finding has not been uniformly observed across all studies. The link between DGF and acute rejection may have changed over time due to advances in immunosuppression and medical management. Here we conducted a cohort study of 645 patients over 12 years to evaluate the association of DGF and biopsy-proven acute rejection (BPAR) in a modern cohort of kidney transplant recipients. DGF was defined as the need for at least one dialysis session in the first week after kidney transplantation. The 1-, 3-, and 5-year cumulative probabilities of BPAR were 16.0, 21.8, and 22.6% in the DGF group, significantly different from the 10.1, 12.4, and 15.7% in the non-DGF group. In multivariable Cox proportional hazards model, the adjusted relative hazard for BPAR in DGF (vs. no DGF) was 1.55 (95% confidence interval (CI): 1.03, 2.32). This association was generally robust to different definitions of DGF. The relative hazard was also similarly elevated for T-cell- or antibody-mediated BPAR (1.52 (0.92, 2.51) and 1.54 (0.85, 2.77), respectively). Finally, the association was consistent across clinically relevant subgroups. Thus DGF remains an important risk factor for BPAR in a contemporary cohort of kidney transplant recipients. Interventions to reduce the risk of DGF and/or its aftereffects remain of paramount importance to improve kidney transplant outcomes.
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31
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Clinical Outcomes Associated With Induction Regimens Among Retransplant Kidney Recipients in the United States. Transplantation 2015; 99:1165-71. [DOI: 10.1097/tp.0000000000000507] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.mesot2014.p21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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33
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Delayed kidney graft function: from mechanism to translation. Kidney Int 2014; 86:251-8. [PMID: 24522494 DOI: 10.1038/ki.2014.18] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 12/16/2022]
Abstract
In as many as 50% of cases the immediate post-kidney transplant course is complicated by delayed graft function that is most commonly related to ischemia and reperfusion injury. In addition to the acute complications related to renal failure and the associated economic impact of prolonged hospitalization, the development of delayed graft function is associated with an increased risk of chronic allograft nephropathy and shortened allograft survival. Challenges in understanding its mechanisms include the complexity, as contributors are derived from both the donor and the recipient. This acute kidney injury is modulated and caused by a complex interplay of events that lead to hypoxic and ischemic injury as well as to altered repair mechanisms. New therapies primarily seek to suppress the inflammatory homing of adaptive immune cells to the kidney, limit cell death, and/or interrupt detrimental signaling of necrosis. Although there are several promising novel targets and innovative therapeutics available, many challenges remain in their translation from bench to bedside. Identifying organs at risk and clearly defined end points will be critical in designing interventional trials.
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Haase-Fielitz A, Haase M, Devarajan P. Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status. Ann Clin Biochem 2014; 51:335-51. [PMID: 24518531 DOI: 10.1177/0004563214521795] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The early prediction of acute kidney injury (AKI) by current clinical and laboratory methods remains inadequate. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising non-invasive biomarker of kidney injury. We systematically reviewed the utility of plasma and urine NGAL measurements for the prediction of AKI in humans. METHODS We searched MEDLINE, PubMed and EMBASE for human biomarker studies that included NGAL (January 2005 to October 2013). Studies reporting on the use of NGAL for the early prediction and prognosis of AKI were analysed in three common clinical settings: cardiac surgery, critical illness and kidney transplantation. RESULTS We identified 58 manuscripts that met our inclusion and exclusion criteria, reporting on more than 16,500 patients. Following cardiac surgery, NGAL measurement in over 7000 patients was predictive of AKI and its severity, with an overall area under the receiver operator characteristic curve (AUC) of 0.82-0.83. Similar results were obtained in over 8500 critically ill patients. In over 1000 patients undergoing kidney transplantation, NGAL measurements predicted delayed graft function with an overall AUC of 0.87. In all three settings, NGAL significantly improved the prediction of AKI risk over the clinical model alone. CONCLUSIONS We identified several studies that collectively strongly support the use of NGAL as a biomarker for the prediction of AKI. However, we noted some limitations, including lack of published studies that adhere to diagnostic study guidelines, heterogeneity in AKI definition, the lack of uniformly applicable cut-off values and variability in the performance of commercially available NGAL assays.
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Affiliation(s)
- Anja Haase-Fielitz
- Department of Nephrology and Hypertension, Diabetes, and Endocrinology, Otto-von-Guericke-University Magdeburg, Germany
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35
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Serum aminoacylase-1 is a novel biomarker with potential prognostic utility for long-term outcome in patients with delayed graft function following renal transplantation. Kidney Int 2013; 84:1214-25. [PMID: 23739232 PMCID: PMC3898105 DOI: 10.1038/ki.2013.200] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 03/14/2013] [Accepted: 03/21/2013] [Indexed: 12/28/2022]
Abstract
Early identification and prognostic stratification of delayed graft function following renal transplantation has significant potential to improve outcome. Mass spectrometry analysis of serum samples, before and on day 2 post transplant from five patients with delayed graft function and five with an uncomplicated transplant, identified aminoacylase-1 (ACY-1) as a potential outcome biomarker. Following assay development, analysis of longitudinal samples from an initial validation cohort of 55 patients confirmed that the ACY-1 level on day 1 or 2 was a moderate predictor of delayed graft function, similar to serum creatinine, complementing the strongest predictor cystatin C. A further validation cohort of 194 patients confirmed this association with area under ROC curves (95% CI) for day 1 serum (138 patients) of 0.74 (0.67-0.85) for ACY-1, 0.9 (0.84-0.95) for cystatin C, and 0.93 (0.88-0.97) for both combined. Significant differences in serum ACY-1 levels were apparent between delayed, slow, and immediate graft function. Analysis of long-term follow-up for 54 patients with delayed graft function showed a highly significant association between day 1 or 3 serum ACY-1 and dialysis-free survival, mainly associated with the donor-brain-dead transplant type. Thus, proteomic analysis provides novel insights into the potential clinical utility of serum ACY-1 levels immediately post transplantation, enabling subdivision of patients with delayed graft function in terms of long-term outcome. Our study requires independent confirmation.
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36
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Gourishankar S, Grebe SO, Mueller TF. Prediction of kidney graft failure using clinical scoring tools. Clin Transplant 2013; 27:517-22. [DOI: 10.1111/ctr.12135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Sita Gourishankar
- Division of Nephrology and Transplant Immunology; University of Alberta; Edmonton; AB; Canada
| | - Scott O. Grebe
- Division of Nephrology; Helios Kliniken Wuppertal; University of Witten-Herdecke; Wuppertal; Germany
| | - Thomas F. Mueller
- Division of Nephrology and Transplant Immunology; University of Alberta; Edmonton; AB; Canada
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37
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Influence of delayed graft function and acute rejection on outcomes after kidney transplantation from donors after cardiac death. Transplantation 2013; 94:1218-23. [PMID: 23154212 DOI: 10.1097/tp.0b013e3182708e30] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Delayed graft function (DGF) and acute rejection (AR) exert an adverse impact on graft outcomes after kidney transplantation using organs from donation after brain-stem death (DBD) donors. Here, we examine the impact of DGF and AR on graft survival in kidney transplants using organs from donation after cardiac death (DCD) donors. METHODS We conducted a single-center retrospective study of DCD and DBD donor kidney transplants. We compared 1- and 4-year graft and patient survival rates, as well as death-censored graft survival (DCGS) rates, between the two groups using univariate analysis, and the impact of DGF and AR on graft function was compared using multivariate analysis. RESULTS Eighty DCD and 206 DBD donor transplants were analyzed. Median follow-up was 4.5 years. The incidence of DGF was higher among DCD recipients (73% vs. 27%, P<0.001), and AR was higher among DBD recipients (23% vs. 9%, P<0.001). One-year and 4-year graft survival rates were similar (DCD 94% and 79% vs. DBD 90% and 82%). Among recipients with DGF, the 4-year DCGS rate was better for DCD recipients compared with DBD recipients (100% vs. 92%, P=0.04). Neither DGF nor AR affected the 1-year graft survival rate in DCD recipients, whereas in DBD recipients, the 1-year graft survival rate was worse in the presence of DGF (88% vs. 96%, P=0.04) and the 4-year DCGS rate was worse in the presence of AR (88% vs. 96%, P=0.04). CONCLUSION Despite the high incidence of DGF, medium-term outcomes of DCD kidney transplants are comparable to those from DBD transplants. Short-term graft survival from DCD transplants is not adversely influenced by DGF and AR, unlike in DBD transplants.
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Sharif A, Borrows R. Delayed graft function after kidney transplantation: the clinical perspective. Am J Kidney Dis 2013; 62:150-8. [PMID: 23391536 DOI: 10.1053/j.ajkd.2012.11.050] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 11/14/2012] [Indexed: 11/11/2022]
Abstract
Delayed graft function continues to pose a significant challenge to clinicians in the context of kidney transplantation. With the present disparity between supply and demand for organs, transplantation is proceeding with more marginal kidneys and therefore the problem of delayed graft function is likely to increase in the future. Although our understanding of the mechanism and risk factors for delayed graft function has improved, translation of this understanding into targeted clinical therapy to attenuate or manage established delayed graft function has been elusive. Based on current trends, the use of kidneys from expanded criteria or cardiac death donors will continue to expand, which will increase the prevalence of delayed graft function in the immediate postoperative setting. The aim of this article is to discuss and critique the available clinical evidence for targeted intervention in the prevention and management of delayed graft function and review emerging and experimental therapies.
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Affiliation(s)
- Adnan Sharif
- Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Israni AK, Leduc R, Jacobson PA, Wildebush W, Guan W, Schladt D, Matas AJ, Oetting WS. Inflammation in the setting of chronic allograft dysfunction post-kidney transplant: phenotype and genotype. Clin Transplant 2013; 27:348-58. [PMID: 23350966 DOI: 10.1111/ctr.12074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Chronic allograft dysfunction (CGD) is a common outcome in kidney transplants, but its pathogenesis is unclear. We investigated the CGD phenotype and single-nucleotide polymorphisms (SNPs) associated with CGD. METHOD This prospective study enrolled 2336 transplants from seven transplant centers in North America. CGD was defined as a >25% rise in serum creatinine relative to a three-month post-transplant baseline, requiring a kidney biopsy. We genotyped 2724 SNPs in the initial 979 transplants, which form the test cohort. RESULTS CGD occurred 11.2 times per 100 person-years at a median of 509 ± 387 days from the three-month baseline. CGD was independently associated with death-censored, allograft failure, in an adjusted analysis [HR=20.6 (11.8-35.8, p < 0.001)]. Among 366 transplant recipients with CGD, 91% had inflammation on biopsy scores. 94 (26%) had inflammatory changes consistent with a diagnosis of concomitant acute rejection. SNPs in FM06 and FM03, potential drug metabolism genes, were associated with CGD, after accounting for multiple testing. CONCLUSION CGD phenotype with concomitant inflammation is associated with increased risk of allograft failure. SNPs associated with CGD in novel drug metabolism and transport genes, will be validated in subsequent transplants.
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Affiliation(s)
- Ajay K Israni
- Nephrology Division, Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN 55415-1829, USA.
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Jayaram D, Kommareddi M, Sung RS, Luan FL. Delayed graft function requiring more than one-time dialysis treatment is associated with inferior clinical outcomes. Clin Transplant 2012; 26:E536-43. [DOI: 10.1111/ctr.12029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Deepa Jayaram
- Internal Medicine; Division of Nephrology; University of Michigan; Ann Arbor; MI; USA
| | - Mallika Kommareddi
- Internal Medicine; Division of Nephrology; University of Michigan; Ann Arbor; MI; USA
| | - Randall S. Sung
- Surgery; Division of Transplantation; University of Michigan; Ann Arbor; MI; USA
| | - Fu L. Luan
- Internal Medicine; Division of Nephrology; University of Michigan; Ann Arbor; MI; USA
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Abstract
Acute kidney injury occurs with kidney transplantation and too frequently progresses to the clinical diagnosis of delayed graft function (DGF). Poor kidney function in the first week of graft life is detrimental to the longevity of the allograft. Challenges to understand the root cause of DGF include several pathologic contributors derived from the donor (ischemic injury, inflammatory signaling) and recipient (reperfusion injury, the innate immune response and the adaptive immune response). Progressive demand for renal allografts has generated new organ categories that continue to carry high risk for DGF for deceased donor organ transplantation. New therapies seek to subdue the inflammatory response in organs with high likelihood to benefit from intervention. Future success in suppressing the development of DGF will require a concerted effort to anticipate and treat tissue injury throughout the arc of the transplantation process.
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Affiliation(s)
- Andrew Siedlecki
- Nephrology Division, Department of Internal Medicine, Washington University in St. Louis School of Medicine, St Louis, MO
| | - William Irish
- CTI, Clinical Trial and Consulting Services, Raleigh, NC
| | - Daniel C. Brennan
- Nephrology Division, Department of Internal Medicine, Washington University in St. Louis School of Medicine, St Louis, MO
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Chang PC, Saha S, Gomes AM, Padiyar A, Bodziak KA, Poggio ED, Hricik DE, Augustine JJ. Donor phosphorus levels and recipient outcomes in living-donor kidney transplantation. Clin J Am Soc Nephrol 2011; 6:1179-84. [PMID: 21310821 DOI: 10.2215/cjn.03220410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES In living-donor kidney transplantation, various donor factors, including gender, age, and baseline kidney function, predict allograft function and recipient outcomes after transplantation. Because higher phosphorus is predictive of vascular injury in healthy adults, the effect of donor phosphorus levels on recipient renal function after transplantation was investigated. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS Phosphorus levels in 241 living donors were analyzed from a 7-year period, and recipient renal function and acute rejection at 1 year posttransplantation were examined controlling for other influencing factors, including multiple donor variables, HLA matching, and acute rejection. RESULTS Female and African-American donors had significantly higher phosphorus levels predonation. By multivariable analysis, higher donor phosphorus correlated with higher recipient serum creatinine (slope=0.087, 95% confidence interval [CI]: 0.004 to 0.169, P=0.041) and lower recipient estimated GFR (slope=-4.321, 95% CI: -8.165 to -0.476, P=0.028) at 12 months. Higher donor phosphorus also displayed an independent correlation with biopsy-proven acute rejection and delayed or slow graft function after transplantation. CONCLUSIONS In a cohort of living kidney donors, higher donor phosphorus correlated with female gender and African-American ethnicity and was an independent risk factor for early allograft dysfunction after living-donor kidney transplantation.
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Affiliation(s)
- Peter C Chang
- Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Kayler LK, Sokolich J, Magliocca J, Schold JD. Import kidney transplants from nonmandatory share deceased donors: characteristics, distribution and outcomes. Am J Transplant 2011; 11:77-85. [PMID: 21199349 DOI: 10.1111/j.1600-6143.2010.03359.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Outcomes of locally rejected kidneys transplanted at other centers (import KTX) are unknown. SRTR data from 2000 to 2009 of deceased-donor KTXs excluding 0-mismatch, paybacks, and other mandatory shares were compared by location of KTX at local (n = 48,165), regional (n = 4428) or national (n = 4104) centers using multivariable regression models. Compared to nonmandatory share local transplants, import KTX were associated with significantly higher overall risks of patient death (regional aHR 1.15, p < 0.01; national aHR 1.14, p < 0.01), and graft failure (regional aHR 1.17, p < 0.01; national aHR1.21, p < 0.01). In paired analysis, the risk of delayed graft function (DGF) for import KTX was higher compared to locally transplanted mates (regional aOR 1.53, p < 0.01, national aOR 2.14, p < 0.01); however, despite longer ischemia times, overall graft survival was similar. Mean cold ischemia times (CIT) pre- and post-DonorNet were similar for local and regional transplants, but significantly higher for national transplants (28.9 ± 9.9 vs. 29.9 ± 9.7 h, respectively, p = 0.01). Import KTX is associated with increased risks of graft failure, patient death and DGF. In the era of DonorNet cold ischemia times of kidneys imported to regional centers are not improved compared to pre-DonorNet; and, those of national centers are significantly prolonged.
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Affiliation(s)
- L K Kayler
- Shands Hospital at the University of Florida Gainesville, FL, USA.
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Assessing and Comparing Rival Definitions of Delayed Renal Allograft Function for Predicting Subsequent Graft Failure. Transplantation 2010; 90:1113-6. [DOI: 10.1097/tp.0b013e3181f86966] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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