Early graft function and patient survival following cadaveric renal transplantation

Woo, Y. Mun; Jardine, Alan G.; Clark, Alan F.; MacGregor, Mark S.; Bowman, Adrian; Macpherson, Stuart; Briggs, J. D.; Junor, B. J. R.; McMillan, Margaret; Rodger, R. S. C.

doi:10.1046/j.1523-1755.1999.00294.x

Cited by 92 publications

(60 citation statements)

References 28 publications

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“…3 Although early kidney dysfunction has a clear adverse effect on long-term allograft survival, there are fewer data on the relationship between early graft function and patient survival. In a retrospective study of 589 recipients of first deceased-donor allografts, mortality was significantly increased in patients with a primary nonfunction (i.e., a graft that never functions) compared with those with less severe graft dysfunction (45 versus 20% at 6 yr) 4 ; however, there was no significant difference in survival among patients with delayed graft function (DGF) versus immediate graft function.…”

mentioning

confidence: 99%

Delayed Graft Function and the Risk for Death with a Functioning Graft

Tapiawala

Tinckam

Cardella

et al. 2010

Journal of the American Society of Nephrology

182

137

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Delayed graft function (DGF) associates with an increased risk for graft failure, but its link with death with graft function (DWGF) is unknown. We used the US Renal Data System to assemble a cohort of all first, adult, deceased-donor kidney transplant recipients from January 1, 1998, through December 31, 2004. In total, 11,542 (23%) of 50,246 recipients required at least one dialysis session in the first week after transplantation. Compared with patients without DGF, patients with DGF were significantly more likely to die with a functioning graft (relative hazard 1.83 [95% confidence interval 1.73 to 1.93] and 1.53 [95% CI 1.45 to 1.63] for unadjusted and fully adjusted models, respectively). The risk for DWGF was slightly higher among women with DGF than among men. There was no significant heterogeneity among other subgroups, and the results were robust to sensitivity analyses. Acute rejection within the first year attenuated the DGF-DWGF association. Cardiovascular and infectious deaths were slightly more prevalent in the DGF group, but the relative hazards of cause-specific death were similar between DWGF and deaths during total follow-up. In summary, DGF associates with an increased risk for DWGF; the mechanisms underlying the negative impact of DGF require further study.

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mentioning

confidence: 99%

Delayed Graft Function and the Risk for Death with a Functioning Graft

Tapiawala

Tinckam

Cardella

et al. 2010

Journal of the American Society of Nephrology

182

137

View full text Add to dashboard Cite

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“…5,9,10 • Need for dialysis during first 7 days after transplant once infection, rejection, and obstruction had been excluded. 12 …”

Section: Dialysis-based Definitionsmentioning

confidence: 99%

“…1,2 It is an important prognostic factor in allograft outcome and is associated with acute rejection episodes and reduced short and long-term graft survival. [3][4][5] Delayed graft function is more common in extended criteria donor (ECD) and donation after cardiac death (DCD) kidneys. [6][7] With a universal organ shortage, lengthening transplant waiting list, and the need to expand the donor pool to include ECD and DCD kidneys, DGF is likely to be a clinical dilemma in the foreseeable future.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Aitken

Cooper²,

Dempster³

et al. 2015

Exp Clin Transplant

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Objectives: Delayed graft function is a significant prognostic indicator after renal transplantation. We hypothesized that delayed graft function is not a single entity, and different patterns of delayed graft function reflect various underlying pathological processes. Materials and Methods: An analysis of 762 renal transplants was performed, showing serum creatinine was charted serially for the first 30 days after transplant. Measurements were obtained: time on hemodialysis; time to peak creatinine; time for creatinine to half; time for creatinine to within 10% of baseline. Results: Four patterns of delayed graft function were identified. There was no association between pattern of delayed graft function, and 1-year graft survival or serum creatinine at 1 year. Time for creatinine to >15 days was associated with a higher creatinine level at 1 year than it was with patients with time for creatinine to half < 5 days (300.6 ± 54.3 vs 211.3 ± 26.0 μmol/L; P < .01). Patients with 1-year creatinine concentrations > 180 μmol/L had longer time on hemodialysis and time for creatinine to half than did those with 1-year creatinine concentrations ≤ 180 μmol/L (9.2 ± 1.3 μmol/L vs 7.0 ± 0.7 μmol/L; P = .03; and 11.6 ± 1.7 μmol/L vs 6.0 ± 0.4 μmol/L; P < .001). Time for creatinine to half of 6.5 days (sensitivity 67.3%; specificity 79.4%; area under the curve, 0.70) was the best predictor of a 1-year creatinine concentration ≤ 180 μmol/L. Conclusions:Delayed graft function is not a single entity; rather; it is the most common presentation of a heterogenous variety of pathologies. Its rate of resolution of renal function is the best predictor of long-term graft outcome.

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“…Studies show that factors affecting graft survival and early graft function (EGF) are donor and recipient age, sex, duration of pretransplant dialysis, mode of renal replacement therapy (RRT), primary renal disease, acute rejection, and postoperative creatinine values at 3, 6, and 12 months. [4][5][6][7] Cold ischemia time was previously thought to have a significant effect on kidney survival; however, this is a debatable matter. 8 A brain-dead donor is often polyuric, hypotensive, and hypernatremic.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Limnell

Schramko²

2018

Exp Clin Transplant

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Objectives: Fluid therapy is required to maintain perfusion to donor organs. Recent reviews on the choices of fluids have emphasized the safety of using crystalloids, as opposed to fluid therapy with colloids, which has been reported to be either unequivocally or potentially harmful in a number of studies on various patient populations. We aimed to analyze whether the type of fluid administered to donors is connected with kidney transplant outcomes. Materials and Methods: A total of 100 consecutive braindead multiorgan donors and their respective 181 kidney recipients were studied retrospectively. Data concerning donor fluid therapy, the charac teristics of the donors and the recipients, and outcomes after kidney transplant were extracted from organ retrieval and patient records. Cases with early graft function were compared with cases with delayed graft function. Results: Donors had received both crystalloids and colloids in most cases (84%). Fluid therapy with crystalloids alone was more common among the 40 recipients with delayed (30%) than in the 103 recipients with early graft function (11%) (P = .005). Donor age, time on renal replacement therapy before transplant, and donor fluid therapy with crystalloids alone were independent risk factors for delayed graft function in multivariate analysis. Conclusions: Our results suggest that donor fluid therapy including colloids could be beneficial instead of harmful compared with treatment with crystalloids alone. This finding needs to be evaluated in prospective studies.

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Early graft function and patient survival following cadaveric renal transplantation

Abstract: Patients with poor levels of early graft function (but not DGF) and those with either acute rejection episodes or early graft loss are at an increased risk of early death. These high-risk groups should be targeted for interventional studies in an attempt to improve patient survival.

Cited by 92 publications

References 28 publications

Delayed Graft Function and the Risk for Death with a Functioning Graft

Delayed Graft Function and the Risk for Death with a Functioning Graft

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