Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation

Budhiraja, Pooja; Reddy, Kunam S.; Butterfield, Richard J.; Jadlowiec, Caroline C.; Moss, Adyr; Khamash, Hassan A.; Kodali, Lavanya; Misra, Suman; Heilman, Raymond L.

doi:10.1186/s12882-022-02777-9

Cited by 22 publications

(13 citation statements)

References 27 publications

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“…These concerns likely limit broader utilization of kidneys at risk for DGF, such as those coming from AKI, high KDPI and DCD donors (8,16). More recent studies have suggested that there is in fact significant heterogeneity within DGF (1)(2)(3)(17)(18). In this cohort, we found that the majority of recipients with DGF had excellent patient and graft survival and lower graft survival was noted only for those with ≥2 readmissions; this finding remained true when accounting for death-censored graft loss (Figure 2) (14-15).…”

Section: Discussionmentioning

confidence: 99%

Association of DGF and Early Readmissions on Outcomes Following Kidney Transplantation

Jadlowiec¹,

Frasco²,

Macdonough³

et al. 2022

Transpl Int

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Concerns regarding outcomes and early resource utilization are potential deterrents to broader use of kidneys at risk for delayed graft function (DGF). We assessed outcomes specific to kidneys with DGF that required early readmission following transplant. Three groups were identified: 1) recipients with DGF not requiring readmission, 2) recipients with DGF having an isolated readmission, and 3) recipients with DGF requiring ≥2 readmissions. Most recipients either required a single readmission (26.8%, n = 247) or no readmission (56.1%, n = 517); 17.1% (n = 158), had ≥2 readmissions. Recipients requiring ≥2 readmissions were likely to be diabetic (53.8%, p = 0.04) and have longer dialysis vintage (p = 0.01). Duration of DGF was longer with increasing number of readmissions (p < 0.001). There were no differences in patient survival for those with DGF and 0, 1 and ≥2 readmissions (p = 0.13). Graft survival, however, was lower for those with ≥2 readmissions (p < 0.0001). This remained true when accounting for death-censored graft loss (p = 0.0012). Additional subgroup analysis was performed on mate kidneys with and without DGF and mate kidneys, both with DGF, with and without readmissions. For these subgroups, there were no differences in patient or graft survival. As a whole, patients with DGF have excellent outcomes, however, patients with DGF requiring ≥2 readmissions have lower graft survival. A better understanding of recipient variables contributing to multiple readmissions may allow for improvements in the utilization of DGF at-risk kidneys.

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Section: Discussionmentioning

confidence: 99%

Association of DGF and Early Readmissions on Outcomes Following Kidney Transplantation

Jadlowiec¹,

Frasco²,

Macdonough³

et al. 2022

Transpl Int

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“…Prolonged CIT is closely associated with DGF 1 . The true clinical significance of DGF on transplant outcomes remains debated although its impact on resources and financial cost is relatively well established 8,22–27 . It is likely that concerns for clinical outcomes, in addition to the increased incidence and duration of DGF, may limit broader use of kidney allografts with longer CIT 25–27 .…”

Section: Discussionmentioning

confidence: 99%

“…1 The true clinical significance of DGF on transplant outcomes remains debated although its impact on resources and financial cost is relatively well established. 8,[22][23][24][25][26][27] It is likely that concerns for clinical outcomes, in addition to the increased incidence and duration of DGF, may limit broader use of kidney allografts with longer CIT. [25][26][27] Difficulty in coordinating logistical transportation is yet another risk factor for prolonging CIT, particularly for difficult-to-place kidneys that have incurred late allocation declines.…”

Section: Discussionmentioning

confidence: 99%

Re‐assessing prolonged cold ischemia time in kidney transplantation through machine learning consensus clustering

Jadlowiec,

Thongprayoon,

Tangpanithandee

et al. 2023

Clinical Transplantation

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BackgroundWe aimed to cluster deceased donor kidney transplant recipients with prolonged cold ischemia time (CIT) using an unsupervised machine learning approach.MethodsWe performed consensus cluster analysis on 11 615 deceased donor kidney transplant patients with CIT exceeding 24 h using OPTN/UNOS data from 2015 to 2019. Cluster characteristics of clinical significance were identified, and post‐transplant outcomes were compared.ResultsConsensus cluster analysis identified two clinically distinct clusters. Cluster 1 was characterized by young, non‐diabetic patients who received kidney transplants from young, non‐hypertensive, non‐ECD deceased donors with lower KDPI scores. In contrast, the patients in cluster 2 were older and more likely to have diabetes. Cluster 2 recipients were more likely to receive transplants from older donors with a higher KDPI. There was lower use of machine perfusion in Cluster 1 and incrementally longer CIT in Cluster 2. Cluster 2 had a higher incidence of delayed graft function (42% vs. 29%), and lower 1‐year patient (95% vs. 98%) and death‐censored (95% vs. 97%) graft survival compared to Cluster 1.ConclusionsUnsupervised machine learning characterized deceased donor kidney transplant recipients with prolonged CIT into two clusters with differing outcomes. Although Cluster 1 had more favorable recipient and donor characteristics and better survival, the outcomes observed in Cluster 2 were also satisfactory. Overall, both clusters demonstrated good survival suggesting opportunities for transplant centers to incrementally increase CIT.

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“…In contrast to our study, a few studies showed no association between DGF and BK viremia. 31,32 Budhiraja et al 33 found that among 1714 DDKTs, of whom 59.4% had DGF, the rate of BK viremia within the first year of the transplant was not significantly different between those with and without DGF (P = 0.24); 116 (16.7%) in no DGF, 106 (14.2%) in DGF lasted ≤14 d, 31 (14.3%) in DGF lasted 15 to 28 d, and 4 (7.7%) in DGF lasted >28 d. A few studies assessed the associations of prolonged cold ischemia time and DCD kidneys, which are also important risk factors for DGF, and found an increased risk of BK replication likely because of ischemiareperfusion injury. 34,35 There are mixed reports assessing the association between DGF and CMV.…”

Section: Discussionmentioning

confidence: 99%

Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia

Alshaikh,

Astor,

Muth

et al. 2023

Transplantation Direct

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Background. Delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs) is a well-known risk factor for allograft rejection, decreased graft survival, and increased cost. Although DGF is associated with an increased risk of rejection, it is unclear whether it also increases the risk of infection. Methods. We reviewed all adult DDKTRs at our center between 2010 and 2018. The primary outcomes of interest were BK viremia, cytomegalovirus viremia, pneumonia, and urinary tract infection (UTI) within the first year of transplant. Additional analysis was made with censoring follow-up at the time of allograft rejection. Results. A total of 1512 DDKTRs were included, of whom 468 (31%) had DGF. As expected, several recipient, donor, and baseline immunological characteristics differed by DGF status. After adjustment, DGF was significantly associated with an increased risk of BK viremia (hazard ratio: 1.34; 95% confidence interval, 1.0-1.81; P = 0.049) and UTI (hazard ratio: 1.70; 95% confidence interval, 1.31-2.19; P < 0.001) but not cytomegalovirus viremia or pneumonia. Associations were similar in models censored at the time of rejection. Conclusions. DGF is associated with an increased risk of early infectious complications, mainly UTI and BK viremia. Close monitoring and appropriate management are warranted for better outcomes in this unique population.

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Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation

Cited by 22 publications

References 27 publications

Association of DGF and Early Readmissions on Outcomes Following Kidney Transplantation

Association of DGF and Early Readmissions on Outcomes Following Kidney Transplantation

Re‐assessing prolonged cold ischemia time in kidney transplantation through machine learning consensus clustering

Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia

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