Assessing and Comparing Rival Definitions of Delayed Renal Allograft Function for Predicting Subsequent Graft Failure

Moore, Jason H.; Shabir, Shazia; Chand, Sourabh; Bentall, Andrew; McClean, Andrew; Chan, Winnie; Jham, Seema; Benavente, David; Sharif, Adnan; Ball, Simon; Cockwell, Paul; Borrows, Richard

doi:10.1097/tp.0b013e3181f86966

Cited by 34 publications

(30 citation statements)

References 9 publications

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“…The heterogeneity in the causes of DGF; the multitude of donor, recipient and procedural factors influencing early graft function; and the variety of definitions used for DGF reflect its limitations as a robust clinical end point and the failure to find reliable biomarkers of kidney quality (4,6,7). In the present report, we evaluated in 91 consecutive deceased donor kidney transplants clinical variables and gene expression profiles in relation to the development of DGF as well as transplant function throughout the first year.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of standardized definitions of DGF as well as the rather weak association between DGF and organ quality are reflected in the controversial results linking DGF with long-term allograft performance and contributes to the current paucity of biomarkers and therapies to affect early and long-term allograft outcome (3,7). Recently, the value of molecular profiles in biopsies taken at time of transplantation to provide the missing information for a more complex understanding and evaluation of organ quality and long-term function have been reviewed (4).…”

Section: Pretransplant Transcriptome Profiles Identify Among Kidneys mentioning

confidence: 99%

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Pretransplant Transcriptome Profiles Identify among Kidneys with Delayed Graft Function Those with Poorer Quality and Outcome

Mas

Scian

Archer

et al. 2011

Mol Med

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Robust biomarkers are needed to identify donor kidneys with poor quality associated with inferior early and longer-term outcome. The occurrence of delayed graft function (DGF) is most often used as a clinical outcome marker to capture poor kidney quality. Gene expression profiles of 92 preimplantation biopsies were evaluated in relation to DGF and estimated glomerular filtration rate (eGFR) to identify preoperative gene transcript changes associated with short-term function. Patients were stratified into those who required dialysis during the first week (DGF group) versus those without (noDGF group) and subclassified according to 1-month eGFR of >45 mL/min (eGFR hi ) versus eGFR of ≤45 mL/min (eGFR lo ). The groups and subgroups were compared in relation to clinical donor and recipient variables and transcriptome-associated biological pathways. A validation set was used to confirm target genes. Donor and recipient characteristics were similar between the DGF versus noDGF groups. A total of 206 probe sets were significant between groups (P < 0.01), but the gene functional analyses failed to identify any significantly affected pathways. However, the subclassification of the DGF and noDGF groups identified 283 probe sets to be significant among groups and associated with biological pathways. Kidneys that developed postoperative DGF and sustained an impaired 1-month function (DGF lo group) showed a transcriptome profile of significant immune activation already preimplant. In addition, these kidneys maintained a poorer transplant function throughout the first-year posttransplant. In conclusion, DGF is a poor marker for organ quality and transplant outcome. In contrast, preimplant gene expression profiles identify "poor quality" grafts and may eventually improve organ allocation.

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Section: Discussionmentioning

confidence: 99%

Section: Pretransplant Transcriptome Profiles Identify Among Kidneys mentioning

confidence: 99%

Pretransplant Transcriptome Profiles Identify among Kidneys with Delayed Graft Function Those with Poorer Quality and Outcome

Mas

Scian

Archer

et al. 2011

Mol Med

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“…DGF resulted superior to the standard DGF definition: however, its importance lied in the simultaneous comparison of donor scores and early postoperative renal function to assess the best "baseline" indicator for later allograft dysfunction (Figure 12). In another recent paper (Moore et al, 2010) dDGF (dialysis-based definition) and extDGF (extended; Boom et al, 2000) were compared (Figure 13). In the multivariable model, extDGF but not dDGF was significantly associated with graft failure (HR 1.47; p-value = 0.02).…”

Section: Comparison Among the Scoring Systemsmentioning

confidence: 99%

Donor Quality Scoring Systems and Early Renal Function Measurements in Kidney Transplantation

Lai¹,

Nudo²,

Morabito³

et al. 2011

Understanding the Complexities of Kidney Transplantation

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“…We defined and analyzed delayed graft function in 2 separate ways: 1) as the temporary need for intermittent hemodialysis in the week following transplantation and 2) as "functional" delayed graft function, namely, need for dialysis or failure of the creatinine concentration to decrease by 10% or more on 3 or more consecutive days during the week following transplantation. 20 Machine perfusion of kidney grafts between the time of procurement and transplantation was not used. Because liver transplantation, lung transplantation and heart transplantation are not performed at our centre, outcomes in recipients could not be determined.…”

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confidence: 99%

Time trends in organ donation after neurologic determination of death: a cohort study

2017

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Background:The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes. Methods:We performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec).Results: There were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p < 0.001). Nationally, the annual number of brain-dead donors with traumatic brain injury decreased from 4.4 to less than 3 per million population between 2000 and 2013, and that with anoxic brain injury increased from 1.1 to 3.1 per million. Donors with anoxic brain injury had higher concentrations of creatinine, alanine aminotransferase and troponin T, and lower P a O 2 /F I O 2 and urine output than donors with other diagnoses. The average number of organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002).Interpretation: Anoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure. AbstractResearch Research CMAJ OPEN E20CMAJ OPEN, 5(1)We performed a cohort study among consecutive braindead donors in southern Alberta to determine whether the distribution of causes responsible for neurologic death has changed (primary outcome) and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes (secondary outcomes). Using data from the Canadian Institute of Health Information (CIHI), we also assessed trends in the cause of neurologic death and number of organs transplanted per donor across Canada. Methods SettingA comprehensive clinical information system (ALTRABase) is used to manage all organ donation referrals in southern Alberta and enables linkage of donor and recipient data. Donor management is in accordance with national guidelines, which are incorporated directly into a region-wide electronic order set. 18 In every case, solid organs are routinely offered to transplantation ...

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Assessing and Comparing Rival Definitions of Delayed Renal Allograft Function for Predicting Subsequent Graft Failure

Cited by 34 publications

References 9 publications

Pretransplant Transcriptome Profiles Identify among Kidneys with Delayed Graft Function Those with Poorer Quality and Outcome

Pretransplant Transcriptome Profiles Identify among Kidneys with Delayed Graft Function Those with Poorer Quality and Outcome

Donor Quality Scoring Systems and Early Renal Function Measurements in Kidney Transplantation

Time trends in organ donation after neurologic determination of death: a cohort study

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