A pair analysis of the delayed graft function in kidney recipient: The critical role of the donor

Robert, René; Guilhot, Joëlle; Pinsard, M.; Longeard, Pol-Louis; Jacob, Jean-Paul; Gissot, Valérie; Hauet, Thierry; François, Sabine

doi:10.1016/j.jcrc.2010.02.011

Cited by 31 publications

(21 citation statements)

References 30 publications

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“…An association of donor smoking with DGF was only seen using bivariate analysis [29] but this relationship became insignificant when adjusted for correlated outcome data [30]. Complement activation is known in both diabetes mellitus [31] and hypertension [32].…”

Section: Risk Factors For Complement Activation In Donor Kidneysmentioning

confidence: 97%

Is Early Complement Activation in Renal Transplantation Associated with Later Graft Outcome?

Bobka

Ebert

Koertvely

et al. 2018

Kidney Blood Press Res

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Background/Aims: Complement activation is important in post-transplantation renal injury, but data on its role as predictor of transplant outcome/complications when assessed in donor kidneys are lacking. Methods: In human renal transplant biopsies with delayed graft function (DGF, n=12), antibody mediated rejection (ABMR, n=8), T-cell mediated rejection (TCMR, n=11), 1 year protocol biopsies (control, n=10) and corresponding zero-biopsies we performed immunohistochemical analyses of 6 complement factors using FFPE sections and correlated the findings with kidney function, as assessed by serum creatinine, and morphological changes including interstitial fibrosis and tubular atrophy (IF/TA). Results: In DGF, TCMR and ABMR significant complement deposition was observed, which was less pronounced in corresponding zero-biopsies. Zero-biopsies with subsequent ABMR showed glomerular complement factor D and C3c expression. Moreover, glomerular C3c and C9 and tubular MASP-2 and Collectin-11 expression in zero-biopsies significantly correlated with serum creatinine at diagnosis of DGF, TCMR or ABMR. Glomerular C1q was significantly increased in ABMR, but not in DGF and TCMR. In contrast, peritubular C1q was significantly enhanced in DGF and TCMR compared to zero-biopsies. Using C3d as a surrogate marker for complement activity we could confirm that stained complement factors are frequently associated with complement activity. Conclusion: Complement deposition strongly correlated with histopathological changes observed in renal transplants. All 3 complement pathways were operational in biopsies with DGF, TCMR and ABMR albeit with differential abundance and localization. Since complement deposition in zero-biopsies correlated with graft function and morphological changes, early specific complement inhibition in renal transplantation may be a new therapeutic option to prevent graft loss.

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Section: Risk Factors For Complement Activation In Donor Kidneysmentioning

confidence: 97%

Is Early Complement Activation in Renal Transplantation Associated with Later Graft Outcome?

Bobka

Ebert

Koertvely

et al. 2018

Kidney Blood Press Res

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“…Graft function: In 1996, one RCT found that more kidney transplant recipients required RRT in the first 8 days if they had received organs from donors after resuscitation with 6% HES 200/0.6 than if donors had been resuscitated with only 3% gelatin [27 (33%) versus 20 (5%), p = 0.029] [53]. Subsequent non-randomized cohort studies confirmed that HES was a risk factor for delayed graft function in these patients [54,55] or found no difference in comparison with fluid therapy with only crystalloids or other colloids [56,57]. A recent RCT which compared 4% gelatin or HES 130/0.4 for resuscitation of 77 living donors found no difference in urine output within 4 days after surgery [58].…”

Section: Synthetic Colloidsmentioning

confidence: 99%

Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

et al. 2012

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We recommend not to use HES with molecular weight ≥ 200 kDa and/or degree of substitution >0.4 in patients with severe sepsis or risk of acute kidney injury and suggest not to use 6% HES 130/0.4 or gelatin in these populations. We recommend not to use colloids in patients with head injury and not to administer gelatins and HES in organ donors. We suggest not to use hyperoncotic solutions for fluid resuscitation. We conclude and recommend that any new colloid should be introduced into clinical practice only after its patient-important safety parameters are established.

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“…La hipotensión es uno de los problemas más frecuentes en los potenciales donantes, siendo una resultante de hipovolemia, vasoplejia, disfunción cardiaca y trastornos hormonales (Figura 1). Más importante, la hipotensión está asociada a una mayor incidencia de necrosis tubular aguda y menor sobrevida a largo plazo de los injertos perfundibles 3,5,14,16 . Además, entre 25 a 40% de los pacientes en muerte encefálica presentan disfunción cardiaca en la ecocardiografía, que puede ser revertida con un buen manejo de fluidos y dosis bajas de drogas vasoactivas e inótropos 17,18 .…”

Section: Manejo Hemodinámico Del Potencial Donante Cadáverunclassified

“…La albúmina tiene pocas ventajas en el manejo general del paciente crítico y se ha asociado a mayor mortalidad en la población neurocrítica, por lo que no es recomendable su uso desde antes que el paciente cumpla criterios de muerte encefálica 25,26 . Los almidones tampoco son recomendados pues en diversas situaciones clínicas aumentan la incidencia de disfunción o falla renal 5,27,29 . Incluso las nuevas formulaciones Aun así, en un hospital con menos recursos humanos especializados, pensamos que la medición seriada de la PVC puede ser útil ya que un alto porcentaje de los donantes son pacientes sanos o no tienen gran inestabilidad hemodinámica.…”

Section: Manejo Hemodinámico Del Potencial Donante Cadáverunclassified

“…La muerte encefálica es una condición catastrófica con marcada inestabilidad circulatoria, que si no es manejada en forma oportuna y adecuada puede llevar al deterioro de los órganos antes de su procuramiento 3,4 . El apropiado manejo del potencial donante antes y después del diagnóstico de muerte encefálica puede mejorar el número y calidad de los órganos procurados (Tablas 1 y 2) 5 . Lamentablemente, aún en la actualidad, muchos potenciales donantes fallecen por un manejo hemodinámico o respiratorio inadecuado.…”

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Manejo del potencial donante cadáver

et al. 2014

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A pair analysis of the delayed graft function in kidney recipient: The critical role of the donor

Cited by 31 publications

References 30 publications

Is Early Complement Activation in Renal Transplantation Associated with Later Graft Outcome?

Is Early Complement Activation in Renal Transplantation Associated with Later Graft Outcome?

Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

Manejo del potencial donante cadáver

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