Clinical Implications of Initial Renal Function After Deceased Donor Transplant

Guimaraes-Souza, Nadia; Dalboni, Maria Aparecida; Canziani, María Eugênia Fernandes; Tedesco‐Silva, Hélio; Batista, MC; Sesso, Ricardo; Câmara, Niels Olsen Saraiva; Medina-Pestana, J.O.; Pacheco-Silva, Álvaro; Cendoroglo, Miguel

doi:10.1016/j.transproceed.2010.03.067

Cited by 6 publications

(4 citation statements)

References 28 publications

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“…In terms of changes to obesity-related comorbidities after KT, we found that while there were improvements among those with hypertension, there were no further improvements in patients with diabetes after transplant. Nevertheless, overall 54% of the patients with diabetes in our study cohort had either an improvement or resolution of their diabetes after SG (results not shown), which is consistent with the pooled estimates from the recent systematic review by Lee et al demonstrating an overall 56% improvement or remission of diabetes after bariatric surgery and prior to KT [ 19 ]. However, there were no reporting of changes in diabetes status subsequent to KT due to lack of data in the available studies [ 20 ].…”

Section: Discussionsupporting

confidence: 91%

“…Graft function in the immediate postoperative period, which included delayed graft function (DGF), slow graft function (SGF), and immediate graft function (IGF), along with serum creatinine and estimated glomerular filtration rate (eGFR) at 90 days and various time points after KT were also evaluated. DGF was clinically defined as the need for dialysis within the first postoperative week and SGF was clinically defined as a slow recovery in kidney function not necessitating dialysis, as done by others [ 19 ]. Biopsy-proven acute and chronic graft rejections were also documented.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study

et al. 2022

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Background Kidney transplantation (KT) is the preferred therapy for end-stage renal disease (ESRD). While a major cause for ESRD, obesity is also a key obstacle to candidacy for KT. Bariatric surgery, particularly sleeve gastrectomy (SG), is increasingly used to improve access to KT in patients with obesity, but the literature especially on outcomes post-KT remains lacking. We aimed to provide a long-term follow-up analysis of efficacy and outcomes of a previously described cohort of patients with obesity, who had SG as a means for access to KT. Methods This is a single-center retrospective follow-up study of 32 patients with advanced chronic kidney disease or ESRD, who were referred and underwent SG between 2013 and 2018 as an access strategy to KT. The primary outcome was successful KT. Ninety-day outcomes, long-term graft function, and changes in weight and obesity-related comorbidities after KT were assessed. Descriptive statistics are presented as count (percentage) or median (interquartile range). Results At baseline, 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m 2 , respectively. Median follow-up time post-SG was 53 (58) months. At last follow-up, 23 (72%) patients received KT. Median time to KT was 16 (20) months and BMI was 34.0 (5.1) kg/m 2 at time of transplant. At KT, 13 (57%) and 20 (87%) had diabetes and hypertension, respectively. Median follow-up post-KT was 16 (47) months. There was one graft loss requiring return to dialysis. At 5-year post-KT, median serum creatinine was 136 (66) µmol/l. At last follow-up post-KT, median BMI remained at 33.7 (7.6) kg/m 2 . Among patients with diabetes and hypertension, 7/13 (54%) and 5/20 (25%) had either improvement or remission of their comorbidities, respectively. Conclusion SG is an effective strategy to improve access to KT in patients with severe obesity. Transplant recipients also continue to benefit from sustained weight loss and improved related comorbidities that may positively impact their graft function after KT. Graphical abstract

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study

et al. 2022

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“…Incidence ranges from 28–38% in kidneys from brain dead donors (DBD)[1–3], and up to 85% in kidneys from donors after circulatory death (DCD)[4–6]. DGF is related to ischemia-reperfusion injury[7–9] and is associated with prolonged hospitalization in addition to an increased risk of complications and acute rejection[7,10–12]. Moreover, in some studies DGF is associated with reduced long-term graft function and graft survival[13].…”

Section: Introductionmentioning

confidence: 99%

P-NGAL Day 1 predicts early but not one year graft function following deceased donor kidney transplantation – The CONTEXT study

et al. 2019

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Background Early markers to predict delayed kidney graft function (DGF) may support clinical management. We studied the ability of four biomarkers (neutrophil gelatinase associated lipocalin (NGAL), liver-type fatty acid-binding protein (L-FABP), cystatin C, and YKL-40) to predict DGF after deceased donor transplantation, and their association with early graft function and GFR at three and twelve months. Methods 225 deceased donor kidney transplant recipients were included. Biomarkers were measured using automated assays or ELISA. We calculated their ability to predict the need for dialysis post-transplant and correlated with the estimated time to a 50% reduction in plasma creatinine (tCr50), measured glomerular filtration rate (mGFR) and estimated GFR (eGFR). Results All biomarkers measured at Day 1, except urinary L-FABP, significantly correlated with tCr50 and mGFR at Day 5. Plasma NGAL at Day 1 and a timed urine output predicted DGF (AUC = 0.91 and AUC 0.98). Nil or only weak correlations were identified between early biomarker levels and mGFR or eGFR at three or twelve months. Conclusion High plasma NGAL at Day 1 predicts DGF and is associated with initial graft function, but may not prove better than P-creatinine or a timed urine output. Early biomarker levels do not correlate with one-year graft function. Trial registration ClinicalTrials.gov NCT01395719

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“…Slow graft function (SGF) was defined as < 30% reduction in serum creatinine on the second day after transplantation. 28 Delayed graft function (DGF) was defined as requiring dialysis within the first 7 days after kidney transplant. Graft failure (GF) was defined as an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m 2 , return to dialysis dependence, or re-transplant during follow-up.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Impact of SIRPα polymorphism on transplant outcomes in HLA‐identical living donor kidney transplantation

García-Sánchez

Casillas-Abundis

Pinelli

et al. 2021

Clinical Transplantation

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Signal-regulatory protein α (SIRPα), a polymorphic inhibitory membrane-bound receptor, and its ligand CD47 have recently been implicated in the modulation of innate immune allorecognition in murine models.Here, we investigate the potential impact of SIRPα donor-recipient mismatches on graft outcomes in human kidney transplantation. To eliminate the specific role of HLAmatching in alloresponse, we genotyped the two most common variants of SIRPα in a cohort of 55 HLA-identical, biologically-related, donor-recipient pairs. 69% of pairs were SIRPα identical. No significant differences were found between donor-recipient SIRPα-mismatch status and T cell-mediated rejection/borderline changes (25.8% vs. 25%) or slow graft function (15.8% vs. 17.6%). A trend towards more graft failure (GF) (23.5% vs. 5.3%, P = .06), interstitial inflammation (50% vs. 23%, P = .06) and significant changes in peritubular capillaritis (ptc) (25% vs. 0%, P = .02) were observed in the SIRPα-mismatched group. Unexpectedly, graft-versus-host (GVH) SIRPα-mismatched pairs exhibited higher rates of GF and tubulitis (38% vs. 5%, P = .031 and .61 ± .88 vs. 0, P = .019; respectively).Whether the higher prevalence of ptc in SIRPα-mismatched recipients and the higher rates of GF in GVH SIRPα-mismatched pairs represent a potential role for SIRPα in linking innate immunity and alloimmune rejection requires further investigation in larger cohorts.

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Clinical Implications of Initial Renal Function After Deceased Donor Transplant

Cited by 6 publications

References 28 publications

Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study

Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study

P-NGAL Day 1 predicts early but not one year graft function following deceased donor kidney transplantation – The CONTEXT study

Impact of SIRPα polymorphism on transplant outcomes in HLA‐identical living donor kidney transplantation

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