Delayed Renal Graft Function: Risk Factors and Impact on the Outcome of Transplantation

Moreira, Pedro; Sá, Helena; Figueiredo, Arnaldo; Mota, A.

doi:10.1016/j.transproceed.2010.12.023

Cited by 40 publications

(26 citation statements)

References 33 publications

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“…Moreira and associates also reported in their retrospective study a significant reduction in long-term graft survival of kidneys after delayed graft function without any effect on patient survival. 23 In our study, delayed graft function did not predict long-term outcome in the general population of elderly donors who were greater than 60 years old.…”

Section: Abbreviations: Cum Cumulativecontrasting

confidence: 53%

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2016

Exp Clin Transplant

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Objectives: We evaluated risk factors that could adversely affect outcomes from elderly deceaseddonor transplants. Materials and Methods:In this single center retrospective study (112 patients), we studied the impact of acute rejection episodes, delayed graft function, donor-recipient age differences, HLA-DR mismatches, HLA antigen mismatches, recipient comorbidities, cold ischemia time, donor and recipient age, and donor serum creatinine level on short-and long-term graft survival. Results: Mean ages of donors and recipients were 64.71 ± 4.09 and 50.39 ± 13.72 years. Delayed graft function was 40.2%, whereas acute rejection episode rate was 38%. Graft and patient survival rates were 80.4% and 67.7%, 63.6% and 91.9%, and 82.1% and 78.2% at 1, 3, and 5 years. Cold ischemia time, recipient comorbidity, and total HLA antigen mismatch did not significantly affect graft outcome. Acute rejection episode was an independent predictor of graft outcome (β level = 2.857, t test = 2.3, P = .025). Donor age was a predictor of total graft survival duration (log-rank test gave chi-square test with 2 df = 12.292, P = .002). Donor estimated glomerular filtration rates ≥ 60 mL/min produced better outcomes than those < 60 mL/min (log-rank test gave chi-squared test with 1 df = 7.213, P = .007). Multivariate Cox regression analysis showed that donor age and delayed graft function were not significant predictors of graft outcome (P > .05), whereas acute rejection episodes (hazard ratio 5.443; 95% confidence interval, 2.226-15.311; P < .001) and donor estimated glomerular filtration rate (hazard ratio 0.449; 95% confidence interval, 0.209-0.945; P = .035) remained significant predictors of cumulative graft survival. Conclusions:The risk factors mentioned above should be avoided to achieve better graft survival. Emphasis should not be on donor age alone. Good donor kidney function and proper immunosuppressive therapy to reduce acute rejection episodes are cornerstones to improved outcomes.

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Section: Abbreviations: Cum Cumulativecontrasting

confidence: 53%

“…22 Moreira and associates reported delayed graft function of 19% among 997 deceased-donor kidney transplants. 23 The incidence of delayed graft function in our study was quite high (40.2%). This may indicate susceptibility of kidneys from elderly donors to delayed graft function.…”

Section: Abbreviations: Cum Cumulativementioning

confidence: 45%

Untitled

2016

Exp Clin Transplant

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“…2,3 Some risk factors have been reported to be related to acute rejection and DGF after kidney transplant, such as higher donor age, long cold ischemia time, repeat transplant, positive panel-reactive antibody test results, and mismatched histocompatibility leukocyte antigen (HLA). [4][5][6] Induction therapy has been widely used to reduce acute rejection and DGF after kidney transplants. Thymoglobulin and basiliximab are the most commonly prescribed medications in induction therapy.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function

Chen

Gu²,

Qiu³

et al. 2013

Exp Clin Transplant

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Objectives: To compare the efficacy and safety of thymoglobulin compared with basiliximab in patients who had kidney transplants and are at high risk for acute rejection and delayed graft function. Materials and Methods: A retrospective review of patients who had 1 or more risk factors for acute rejection and delayed graft function and who were given either thymoglobulin or basiliximab for induction therapy. Incidences of acute rejection, antibody-treated acute rejection, delayed graft function, chronic rejection, cancer, infection, leucopenia, and thrombocytopenia were compared between thymoglobulin and basiliximab groups. Serum creatinine levels within 1 year and long-term graft and patient survival also were compared. Results: A total of 327 patients were included. Incidences of acute rejection, antibody-treated acute rejection, delayed graft function, and chronic rejection were significantly lower in the thymoglobulin group than in the basiliximab group (P < .05). Serum creatinine levels were lower in the thymoglobulin group on postoperative days 7, 14, and 30 (P < .05). There were no statistically significant differences regarding long-term graft and patient survival, cancer, or total infection rate between the groups. Incidences of Cytomegalovirus infection, leucopenia, and thrombocytopenia were significantly higher in the thymoglobulin group (P < .05). Conclusions:Thymoglobulin may improve shortterm outcomes, compared with basiliximab, in patients who had kidney transplants and are at high risk for acute rejection and delayed graft function. However, long-term outcomes are similar with thymoglobulin and basiliximab.

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“…This would suggest the effect of delayed graft function was reduced over the period of the study as it is known to affect function and survival over shorter periods of follow-up. 24 It has also been shown that histological damage done due to delayed graft function and CIT does not have a lasting effect on function. 25 CITs of the patients included in the study showed relatively minimal variance between groups which could account for its lack of influence.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting eGFR 5-year post-deceased donor renal transplant: analysis and predictive model

et al. 2015

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Aim: Long-term survival of renal allografts has improved over the last 20 years. However, less is known about current expectations for long-term allograft function as determined by estimated glomerular filtration rate (eGFR). The aim of this study was to investigate factors which affect graft function at 5 years' post-renal transplantation. The statistically significant factors were then used to construct a predictive model for expected eGFR at five years' post-transplant. Methods: We retrospectively reviewed all adult patients who received a renal transplant in the Republic of Ireland between 1990 and. Data collected included era of transplantation (1990-1994, 1995-1999, 2000-2004), donor and recipient age and gender, number of human leucocyte antigen mismatches, cold ischemia time (CIT), number of prior renal transplants, immunosuppressive regimen used and acute rejection episodes. Estimated GFR was calculated at 5 years after transplantation from patient data using the Modified Diet in Renal Disease (MDRD) equation. Consecutive sampling was used to divide the study population into two equal unbiased groups of 489 patients. The first group (derivation cohort) was used to construct a predictive model for eGFR five years' post-transplantation, the second (validation cohort) to test this model. Results: Nine hundred and seventy eight patients were analyzed. The median age at transplantation was 43 years (range 18-78) and 620 (63.4%) were male. One hundred and seventy five patients (17.9%) had received a prior renal transplant. Improved eGFR at five years' post-transplantation was associated with tacrolimus-based combination immunosuppression, younger donor age, male recipient, absence of cytomegalovirus disease and absence of acute rejection episodes as independently significant factors (p50.05). The predictive model developed using these factors showed good correlation between predicted and actual median eGFR at five years. The model explained 20% of eGFR variability. The validation model findings were consistent with the derivation model (21% variability of eGFR explained by model using same covariates on new data). Conclusion: The predictive model we have developed shows good correlation between predicted and actual median eGFR at five years' post-transplant. Applications of this model include comparison of current and future therapy options such as new immunosuppressive regimens.

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Delayed Renal Graft Function: Risk Factors and Impact on the Outcome of Transplantation

Cited by 40 publications

References 33 publications

Untitled

Untitled

Efficacy and Safety of Thymoglobulin and Basiliximab in Kidney Transplant Patients at High Risk for Acute Rejection and Delayed Graft Function

Factors affecting eGFR 5-year post-deceased donor renal transplant: analysis and predictive model

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