A retrospective study of the relationship between postoperative urine output and one year transplanted kidney function

Abstract

Background: Kidney transplantation (KT) is the most obvious method of treating a patient with end-stage renal disease. In the early stages of KT, urine production is considered a marker of successful reperfusion of the kidney after anastomosis. However, there is no clear conclusion about the relationship between initial urine output after KT and 1-year renal function. Thus, we investigated the factors that affect 1-year kidney function after KT, including urine output. Methods: This retrospective study investigated the relationship between urine output in the 3 days after KT and transplanted kidney prognosis after 1-year. In total, 291 patients (129 living-donor and 162 deceased-donor transplant recipients) were analyzed; 24-h urine volume per body weight (in kilograms) was measured for 3 days postoperatively. The estimated glomerular filtration rate (eGFR), determined by the Modification of Diet in Renal Disease algorithm, was used as an index of renal function. Patients were grouped according to eGFR at 1-year after KT: a good residual function group, eGFR ≥60, and a poor residual function group, eGFR < 60. Result: Recipients' factors affecting 1-year eGFR include height (P = 0.03), weight (P = 0.00), and body mass index (P = 0.00). Donor factors affecting 1-year eGFR include age (P = 0.00) and number of human leukocyte antigen (HLA) mismatches (P = 0.00). The urine output for 3 days after KT (postoperative day 1; 2 and 3) was associated with 1-year eGFR in deceased-donor (P = 0.00; P = 0.00 and P = 0.01). And, postoperative urine output was associated with the occurrence of delayed graft function (area under curve (AUC) = 0.913; AUC = 0.984 and AUC = 0.944). Conclusion: Although postoperative urine output alone is not enough to predict 1-year GFR, the incidence of delayed graft function can be predicted. Also, the appropriate urine output after KT may differ depending on the type of the transplanted kidney. Trial registration: Clinical Research Information Service of the Korea National Institute of Health in the Republic of Korea (KCT0003571).

Development and validation of a nomogram to predict the mortality risk in elderly patients with ARF

“…Our study also showed that urinary output was superior to serum creatinine in predicting short-term mortality of elderly patients with ARF. Although the assessment of AKI stage is not necessarily based on urine volume, the initial postoperative urine volume was considered an accurate predictor of delayed graft function ( Kim et al, 2019 ). The reduction of urinary output can be attributed to insufficient blood flow to the kidneys, due to reduced blood volume and systolic pressure.…”

Development and Validation of a Nomogram to Predict the Mortality Risk in Elderly Patients With ARF：A Retrospective Study in the Mimic-III Database

“…Our study also showed that urinary output was superior to serum creatinine in predicting short-term mortality of elderly patients with ARF. Although, the assessment of AKI stage is not necessarily based on urine volume, the initial postoperative urine volume was considered an accurate predictor of delayed graft function [14]. The reduction of urinary output can be attributed to insu cient blood ow to the kidneys, due to reduced blood volume and systolic pressure.…”

Phase 3 trial Design of the Hepatocyte Growth Factor Mimetic ANG-3777 in Renal Transplant Recipients With Delayed Graft Function

“…Recipients of DCD kidneys are capped at 20%, as some studies have shown that DCD kidneys may be prone to worse outcomes, 31 , 32 , 33 though this observation remains controversial. 34 , 35 Although differing outcomes across studies may be due to magnitude of ischemic reperfusion injury, generally greater in DCD kidneys, versus the increased propensity for repair, generally improved in the typically younger DCD donor organs, we sought to approximate current clinical practice by the cap on DCD kidneys. Kidneys may be preserved by static cold storage or cold pulsatile machine perfusion, with the latter capped at 40% to reflect current practice as quantified in the Organ Procurement and Transplantation Network (OPTN) database.…”

“…No serious adverse events were assessed as related to study drug. have shown that DCD kidneys may be prone to worse outcomes [31][32][33] , though this observation remains controversial 34,35 . While differing outcomes across studies may be due to magnitude of ischemic reperfusion injury, generally greater in DCD kidneys, versus the increased propensity for repair, generally improved in the typically younger DCD donor organs, we sought to In the Phase 2 trial, both eGFR and graft failure had effect sizes sufficient to reach statistical significance.…”