A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors

Chapal, Marion; Borgne, Françoise Le; Legendre, Christophe; Kreis, Henri; Mourad, Georges; Garrigue, Valérie; Morélon, Emmanuel; Buron, Fanny; Rostaing, Lionel; Kamar, Nassim; Kessler, Michèle; Ladrière, Marc; Soulillou, Jean‐Paul; Launay, Katy; Daguin, Pascal; Offredo, Lucile; Giral, Magali; Foucher, Yohann

doi:10.1038/ki.2014.188

Cited by 90 publications

(98 citation statements)

References 46 publications

(64 reference statements)

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“…A recent randomized trial showed that 31.5% of patients in an ATG group developed DGF compared with 44.6% using anti-interleukin 2 receptor antibody treatment. Chapal et al also found five explicative variables that contributed significantly to DGF prediction, and demonstrated that risk of DGF was reduced 1.73-fold in patients with ATG [6]. Other studies also demonstrated significantly lower rates of DGF in ATG-induced DCD recipients [24][25][26].…”

Section: Discussionmentioning

confidence: 85%

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

Sun

Huang

Zhou

et al. 2018

Kidney Blood Press Res

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Background/Aims: Delayed graft function (DGF) is a common complication following kidney transplantation adversely affecting graft outcomes. Donation after brain death followed by circulatory death (DBCD), a novel donation pattern, is expected to correlate with high incidence of DGF. However, little information is available about factors associated with DGF in DBCD. Methods: A total of 383 kidney transplants from DBCD donation in three institutions were enrolled. Associations of DGF with the clinical characteristics of recipients and donors were quantified. Results: In this retrospective multi-center study, the incidence of DGF was 19.3%. Lower incidence of DGF was found in recipients for whom antithymocyte globulin was used for induction (p < 0.05), which was an independent protective factor against DGF (odds ratio [OR] = 0.48; 95% CI 0.27-0.86). Two novel explicative variables were recognized as independent risk factors, including use of vasoactive drugs (OR = 3.15; 95% CI 1.39-7.14) and cardiopulmonary resuscitation (OR = 2.51; 95% CI 1.05-6.00), which contributed significantly to increased risk of DGF (p < 0.05). Prolonged warm ischemia time (> 18 min; OR = 2.42; 95% CI 1.36-4.32), was also predictive of DGF in DBCD. A prediction model was developed and achieved an area under the curve of 0.89 in predicting DGF when combined with reported parameters. Conclusion: The novel factors, confirmed for the first time in our study, will help to improve risk prediction of DGF and to determine optimal interventions to prevent DGF in clinical practice.

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Section: Discussionmentioning

confidence: 85%

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

Sun

Huang

Zhou

et al. 2018

Kidney Blood Press Res

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“…In fact, none of the available predictive models includes in final formula variables reflecting donor maintenance. Except for terminal serum creatinine (that could reflect renal consequences of hypovolemia, shock and other causes of acute kidney injury), only the score developed by Chapal et al analyzed some variable related to donor care (type of vasopressor) [24].…”

Section: Discussionmentioning

confidence: 99%

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

et al. 2020

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BackgroundThis study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. MethodsA total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. ResultsMost patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, � 1 or high dose vasopressors and blood glucose.

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“…In 2009, Jeldres et al [18] proposed a simpler model requiring 6 variables based on the Canadian population. Furthermore, the French multicenter study group also designed a score [19] (called DGFS; www.divat.fr/en/online-calculators/dgfs) by using 5 variables. These models used only pre-implantation risks to predict DGF.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the importance of early detection of DGF in KT, several previous studies had developed models for predicting the likelihood of DGF [16][17][18][19]. These predicting models mostly used pre-implantation risk factors to forecast DGF.…”

Section: Introductionmentioning

confidence: 99%

Furosemide Stress Test as a Predicting Biomarker for Delayed Graft Function in Kidney Transplantation

Udomkarnjananun¹,

Townamchai²,

Iampenkhae³

et al. 2019

Nephron

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Background: Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF. Materials and methods: This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL). Results: Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986–0.999, p = 0.035) for the 4-h urine volume to predict DGF. Conclusions: The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.

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A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors

Cited by 90 publications

References 46 publications

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

Furosemide Stress Test as a Predicting Biomarker for Delayed Graft Function in Kidney Transplantation

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