Impact of pretransplant dialysis on early graft function in pediatric kidney recipients* (original) (raw)
Related papers
Pediatric En Bloc Kidney Transplants Reduce DGF and Are Misrepresented by the KDPI
American Journal of Transplant, 2016
Controversy exists regarding optimal use of kidneys from small pediatric donors (SPDs). The study purpose was to compare outcomes between single and dual en bloc (EB) kidney transplants (KT) from SPDs in the context of the Kidney Donor Pro_le index (KDPI). METHODS: Single center retrospective review of KTs from SPDs ≤5 years of age. Recipient selection included low BMI, middle-aged adults at low immunologic risk. All patients (pts) received depleting antibody induction with FK/MMF/prednisone. RESULTS: From 2002-2015, 59 KTs were performed from SPDs including 34 dual EB and 25 single KTs. Mean donor age (17 vs 38 months, p<0.001), mean weight (11.0 vs 17.4 kg, p=0.046) and male donors (50% vs 84%, p=0.01) were lower in the EB compared to the single KT group, respectively. Mean cold ischemia time (21 hours), KDPI (73% vs 62%) and serum creatinine (SCr) levels (0.37 vs 0.49 mg/dl, all p=NS) were comparable in the EB and single KT groups, respectively. Other than mean recipient age (38 EB vs 46 years single KT, p=0.04), there were no significant differences in pt characteristics between groups. With a mean follow-up of 5 years, actual pt (94% vs 80%, p=0.12) and graft survival (GS, 91% vs 68%, p=0.04) rates were slightly higher in EB compared to single KT, respectively (Table 2). Death-censored kidney GS rates were 93.9% and 81% (p=0.19), respectively. Delayed graft function incidence (12% EB vs 20% single KT, p=NS) was slightly lower in EB KT pts. Mean 4-year SCr and GFR levels, which improved over time in both groups, were 1.0 vs 1.17 mg/dl and 81 vs 64 ml/min/1.73 m (both p=NS) in the EB and single KT groups. EB KT outcomes were comparable to concurrent living donor KTs and superior to standard criteria donor (SCD) KTs at our center whereas outcomes following single KT from SPDs were inferior to living donor KTs and similar to concurrent SCD KTs. Based on actual 5-year GS, the projected KDPIs of EB and single KTs from SPDs were <1% and 65%. CONCLUSION: With appropriate pt selection, excellent mid-term outcomes can be achieved by KT from SPDs into adult recipients. KDPI is predictive of survival for single KT but is not accurate for predicting EB KT outcomes from SPDs. To cite this abstract in AMA style: Khan M, El-Hennawy H, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Gautreaux M, Iskandar S, Doares W, Kaczmorski S, Stratta R. Pediatric En Bloc Kidney Transplants Reduce DGF and Are Misrepresented by the KDPI. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/pediatric-en-bloc-kidneytransplants- reduce-dgf-and-are-misrepresented-by-the-kdpi/. Accessed April 29, 2019.
Delayed Graft Function and Long-Term Outcome in Kidney Transplantation
Transplantation Proceedings, 2012
BACKGROUND: There are still many controversies about the impact of delayed graft function (DGF) on kidney transplantation outcome. The aims of this study were to define factors associated with DGF and to ascertain the relative impact of DGF on kidney transplantation outcome, both in the early postoperative period and in long-term follow-up.
Pediatric Transplantation, 2010
Otukesh H, Hosein R, Fereshtehnejad S-M, Riahifard A, Basiri A, Simforoosh N, Chalian M, Jazayeri S, Chalian H, Safarzadeh AE, Sharifian M, Hoseini S. Short-term and long-term effects of slow graft function on graft survival in pediatric live donor renal transplantation. Pediatr Transplantation 2010:14:196–202. © 2009 John Wiley & Sons A/S.Abstract: SGF generally has early and long-term consequences for allograft survival. Limited studies have been performed on SGF and its complications in pediatric renal transplantation. Therefore, 230 children who received transplants between 1985 and 2005 in Labafi Nejad hospital were included in this study. SGF was defined if the serum creatinine level increased, remained unchanged, or decreased by <10% per day immediately after surgery during three consecutive days in the first week after transplantation. The children were divided into two groups: 183 children in group A (non-SGF) and 47 patients in group B (SGF). The impact of SGF on renal function within the first year, long-term graft survival and post-transplantation complications were analyzed and compared using logistic regression model and Kaplan–Meier survival analysis. The incidence of graft failure at the end of follow-up period was significantly more common in SGF group (53.2% vs. 22.4%, p < 0.001). The median survival time was 140.25 (s.e.m. = 19.35) months in group A (non-SGF) and 60 (s.e.m. = 17.90) months in group B (SGF) (p < 0.001). The graft survival rate was 94.9%, 91.9%, 83.9%, 79.2%, and 72% at one, three, five, seven, and twelve yr after transplantation in children without SGF vs. 75.6%, 53.2%, 47.2%, 40% at one, three, five, and seven yr after transplantation in patients with SGF. The results of our study showed that slow graft function could remarkably affect graft survival and worsen both short-term and long-term transplantation outcomes. Thus, the prevention of SGF is one of the most important issues in graft survival improvement.
Transplantation Proceedings, 2010
Introduction. Kidney transplantation is the best treatment for end-stage renal disease patients. Delayed graft function (DGF) remains one of the major problems after cadaveric kidney transplantation. This study has reported the risk factors and outcomes of DGF using data from Thai Transplant Registry Database. Methods. The data of all cadaveric kidney transplantations (CD-KT) were retrieved from the database. DGF was defined as a failure to decrease the serum creatinine within 72 hours or a requirement for dialysis within the first week after transplantation. We performed logistic regression analysis to correlate donor features (age, sex, cardiopulmonary resuscitation (CPR), brain death from a cerebrovascular accident (CVA), best and last serum creatinine) with recipient demographics (age, sex) and clinical outcomes cold ischemic time [CIT] and DGF. Results. We analyzed 756 CD-KT including 320 (42%) patients experiencing DGF. Upon multivariate analysis, factors significantly correlated with DGF were CIT (P Ͻ .001), donor last serum creatinine (P Ͻ .001), interleukin 2 monoclonal antibody induction (P ϭ .004), donor age (P ϭ .017), donor CVA (P ϭ .012), and prior peritoneal dialysis (PD) (P ϭ .012). There was no significant correlation between DGF and donor height, weight, sex, CPR, brain death from CVA, best serum creatinine, recipient age, or sex in multivariate analysis.
Nephrology Dialysis Transplantation, 2012
We hypothesized that supplementing a higher mass of renal parenchyma from adult donors, and their younger age, would improve graft function in paediatric recipients. We calculated estimated glomerular filtration rate (eGFR; Schwartz formula) and absolute glomerular filtration rate (absGFR) in 57 renal-grafted children (1995-2007) aged 3.1-17.9 years, weighing 12.9-85.0 kg, on discharge from the hospital after transplantation (TPL), 1 year after TPL and at the last follow-up (1.5-11.7 years after TPL). We correlated their eGFR with the individual ratio between the donor and the recipient body weight at the time of TPL (donor/recipient body weight ratio; D/R BWR), and we evaluated the effect of the donor and the actual recipient body weight on the eGFR and absGFR. The D/R BWR varied from 0.65 to 5.23. We found a significant positive correlation between D/R BWR and eGFR at discharge from the hospital (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), 1-year post-TPL (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and at the last follow-up (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Using multiple linear regression analyses, we found that both eGFR and absGFR values were much more determined by the actual recipient weight than by the donor weight (27/6% and 43/4% at discharge, by 24/4% and 57/0% 1 year after TPL, and 0/0% and 20/0% at the end of the follow-up). A tendency for lower eGFR with increasing age of donors was apparent at discharge and 1 year after TPL, but it reached statistical significance only at the last follow-up (r = 0.4254, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). In paediatric renal transplants, the value of D/R BWR directly correlated with eGFR in the early and late posttransplant periods. However, this correlation was mainly influenced by the recipient weight, while the donor weight played only a minor or negligible role.
Risk factors and consequences of delayed graft function in renal transplantation
2021
Background/Aim: Delayed graft function (DGF) continues to be an important complication in patients who underwent kidney transplantation. Our study aimed to determine the rate of DGF and risk factors after renal transplantation at our center and explore DGF-related complications and outcomes. Methods: Patients over 18 years of age who underwent kidney transplantation between January 2015 and January 2020 were evaluated. DGF was defined as the need for at least one dialysis session within the first week after renal transplantation. The factors affecting DGF were analyzed as the primary outcome, and discharge and additional complications, as the secondary outcomes. Results: Data of 206 patients who underwent renal transplantation were analyzed, and delayed graft function (the need for at least one dialysis session within the first week after renal transplantation) was observed at a rate of 20.9%. A statistically significant relationship was observed between DGF and presence of diabetes...
Prolonged Delayed Graft Function Is Associated with Inferior Patient and Kidney Allograft Survivals
PLOS ONE, 2015
It is unclear if there is an association between the duration of delayed graft function (DGF) and kidney transplant (KT) outcomes. This study investigated the impact of prolonged DGF on patient and graft survivals, and renal function one year after KT. This single center retrospective analysis included all deceased donor KT performed between Jan/1998 and Dec/2008 (n = 1412). Patients were grouped in quartiles according to duration of DGF (1-5, 6-10, 11-15, and >15 days, designated as prolonged DGF). The overall incidence of DGF was 54.2%. Prolonged DGF was associated with retransplantation (OR 2.110, CI95% 1.064-4.184,p = 0.033) and more than 3 HLA mismatches (OR 1.819, CI95% 1.117-2.962,p = 0.016). The incidence of acute rejection was higher in patients with DGF compared with those without DGF (36.2% vs. 12.2%, p<0.001). Compared to patients without DGF, DGF(1-5), DGF(6-10), and DGF(11-15), patients with prolonged DGF showed inferior one year patient survival (95.2% vs. 95.4% vs. 95.5% vs. 93.4% vs. 88.86%, p = 0.003), graft survival (91% vs. 91.4% vs. 92% vs. 88.7% vs. 70.5%, p<0.001), death-censored graft survival (95.7% vs. 95.4% vs. 96.4% vs. 94% vs. 79.3%, p<0.001), and creatinine clearance (58.0±24.6 vs. 55.8±22.2 vs. 53.8±24.1 vs. 53.0±27.2 vs. 36.8±27.0 mL/min, p<0.001), respectively. Multivariable analysis showed that prolonged DGF was an independent risk factor for graft loss (OR 3.876, CI95% 2.270-6.618, p<0.001), death censored graft loss (OR 4.103, CI95% 2.055-8.193, p<0.001), and death (OR 3.065, CI95% 1.536-6.117, p = 0.001). Prolonged DGF, determined by retransplantation and higher HLA mismatches, was associated with inferior renal function, and patient and graft survivals at one year.