Similar Outcomes with Different Rates of Delayed Graft Function May Reflect Center Practice, Not Center Performance

Akkina, Sanjeev; Connaire, Jeffrey; Israni, Ajay K.; Snyder, Jon J.; Matas, Arthur J.; Kasiske, Bertram L.

doi:10.1111/j.1600-6143.2009.02651.x

Cited by 49 publications

(50 citation statements)

References 19 publications

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“…However, this definition as a marker of renal excretory function (i.e., glomerular filtration rate [GFR]) and a risk-stratification metric has limitations. Specifically, patients may be prescribed dialysis in the postoperative period (and therefore fulfill criteria for DGF) based on a nonstandardized and subjective opinion of the clinician, sometimes driven by determinants that may not necessarily solely reflect GFR, such as volume overload, hyperkalemia, or acidosis, and that may vary from clinician to clinician and center to center (3). Conversely, the requirement for dialysis may reflect the extreme of the spectrum of suboptimal renal function, lack of dialysis requirement does not imply perfect allograft function, and long-term graft survival may be well shortened even in patients not requiring dialysis (and therefore not meeting the traditional criterion for DGF).…”

mentioning

confidence: 99%

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

et al. 2010

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confidence: 99%

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

et al. 2010

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“…Delayed graft function was defined as the need for dialysis during the first week after kidney transplant. 1 Immediately after kidney transplant, 4 different types of clinical course of delayed renal graft function were defined: anuria, oliguria, adequate amount of urine, and secondary delayed function (several days of polyuria followed by decreased urine output including anuria). Ischemia was a leading cause of early delayed renal graft function (Tables 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] In recent years, more patients who previously were not considered transplant candidates have been referred for kidney transplant. We reviewed the effects of different factors on development and outcome of early kidney allograft dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2015

Exp Clin Transplant

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Objectives: To show the effects of different factors on development and outcome of early kidney allograft dysfunction. Materials and Methods: Two hundred thirty-one kidney transplant recipients were divided into 2 groups: group 1 (125 patients transplanted from 1999-2004) and group 2 (106 patients transplanted from 2008-2013). Age range was 12 to 62 years (group 1) and 7 to 71 years (group 2). Deceaseddonor transplant was more frequent in group 1 (76.8%), and living-donor transplant in group 2 (68.8%). In group 1, transplant was performed for glomerulonephritis or pyelonephritis; in group 2, additional risk factors (18 patients) included diabetes (11 patients), systemic lupus erythematosus (5 patients), amyloidosis (1 patient), and aortic and mitral valve replacement because of bacterial endocarditis (1 patient). In groups 1 and 2, immunosuppression after transplant included cyclosporine, mycophenolate mofetil, and steroids; patients in group 2 also had induction with anti-CD25 monoclonal antibodies. Results: Primary graft function occurred in 89 patients in group 1 (71.2%) and 83 patients in group 2 (78.3%). Immediately after transplant, delayed graft function included anuria, oliguria, adequate amount of urine, and secondary delayed function (several days of polyuria followed by decreased urine output). Ischemia was a leading cause of delayed renal graft function. Anuria after livingdonor transplant was a sign of vascular thrombosis. Rejection was the main cause of secondary delayed graft function, which occurred in only group 1. Survival at 1 year in patients with delayed graft function was 80% in group 1 and 100% in group 2 because of the absence of septic complications. Conclusions: Despite extension of indications, primary functioning of kidney transplants and patient survival increased. Improved care enables long-term rehabilitation of recipients and expanding criteria for kidney transplant.

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“…Chronic changes were analyzed from donor biopsies including global glomerulosclerosis (any), tubular atrophy and interstitial fibrosis (using Banff scoring (12)), presence of arteriosclerosis (any), and presence of calcinosis. Delayed graft function (DGF) was analyzed and defined as the need for dialysis therapy within 1 week of transplantation, and slow graft function (SGF) was defined as a recipient serum Cr Ն 3 mg/dl on postoperative day 5 (13). Recipient serum Cr was also recorded at 12 months posttransplantation, and recipient eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation.…”

Section: Patient Populationmentioning

confidence: 99%

Donor Phosphorus Levels and Recipient Outcomes in Living-Donor Kidney Transplantation

Chang¹,

Saha²,

Gomes³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives In living-donor kidney transplantation, various donor factors, including gender, age, and baseline kidney function, predict allograft function and recipient outcomes after transplantation. Because higher phosphorus is predictive of vascular injury in healthy adults, the effect of donor phosphorus levels on recipient renal function after transplantation was investigated.Design, setting, participants, and measurements Phosphorus levels in 241 living donors were analyzed from a 7-year period, and recipient renal function and acute rejection at 1 year posttransplantation were examined controlling for other influencing factors, including multiple donor variables, HLA matching, and acute rejection.Results Female and African-American donors had significantly higher phosphorus levels predonation. By multivariable analysis, higher donor phosphorus correlated with higher recipient serum creatinine (slope ϭ 0.087, 95% confidence interval [CI]: 0.004 to 0.169, P ϭ 0.041) and lower recipient estimated GFR (slope ϭ Ϫ4.321, 95% CI: Ϫ8.165 to Ϫ0.476, P ϭ 0.028) at 12 months. Higher donor phosphorus also displayed an independent correlation with biopsy-proven acute rejection and delayed or slow graft function after transplantation. ConclusionsIn a cohort of living kidney donors, higher donor phosphorus correlated with female gender and African-American ethnicity and was an independent risk factor for early allograft dysfunction after living-donor kidney transplantation.

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Similar Outcomes with Different Rates of Delayed Graft Function May Reflect Center Practice, Not Center Performance

Cited by 49 publications

References 19 publications

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

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

Untitled

Donor Phosphorus Levels and Recipient Outcomes in Living-Donor Kidney Transplantation

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