Delayed Graft Function, Acute Rejection, and Outcome After Cadaver Renal Transplantation

Troppmann, Christoph; Gillingham, Kristen J.; Benedetti, Enrico; Almond, P. S.; Gruessner, R.; Najarian, J. S.; Matas, A. J.

doi:10.1097/00007890-199504150-00007

Cited by 469 publications

(240 citation statements)

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“…This result could be anticipated taking into consideration that DGF is associated with an increased recruitment of inflammatory cells and an increased risk for the development of acute rejection (32,33). Even in rejection-free patients, DGF is an independent risk factor for late graft failure owing to CAN (34).…”

Section: Progression Of Chronic Allograft Nephropathymentioning

confidence: 97%

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

Moreso

López

Vallejos

et al. 2001

American Journal of Transplantation

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Aim: To evaluate the utility of intimal thickness and interstitial width as a primary efficacy variable in the design of clinical trials aimed to modify the natural history of chronic allograft nephropathy. Methods: A donor and a 4-month protocol biopsy were evaluated in 40 stable grafts according to the Banff schema. In 27 patients, a second protocol biopsy was done at 1 yr. Arterial intimal volume fraction (Vvintima/ artery) and cortical interstitial volume fraction (Vvinterstitium/cortex) were estimated with a point counting technique. Results: Chronic Banff scores increased during followup, while acute scores reached its peak at 4 months. Vvintima/artery and Vvinterstitium/cortex significantly increased at 4 months, but not at 1 yr. Vvintima/artery at 4 months correlated with donor Vvintima/artery (r Ω0.57, p ∞0.001), histocompatibility (r Ω0.38, p Ω 0.01) and serum cholesterol (r Ω0.31, p Ω0.047). Vvinterstitium/cortex at 4 months correlated with recipient body surface area (r Ω0.44, p Ω0.004) and delayed graft function (p Ω0.016). Power calculations showed that Vvintima/artery and Vvinterstitium/cortex allow an important reduction in minimum sample size of a hypothetical trial aimed to prevent chronic allograft nephropathy. Conclusions: Intimal thickening and interstitial widening progresses rapidly during the first 4 months after transplantation and slowly thereafter. These parameters can be considered as a primary efficacy variable in trials aimed to prevent chronic allograft nephropathy.

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Section: Progression Of Chronic Allograft Nephropathymentioning

confidence: 97%

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

Moreso

López

Vallejos

et al. 2001

American Journal of Transplantation

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“…Our finding parallels results from studies within the general transplant population that have demonstrated an association between prolonged CIT and increased risks for the development of delayed graft function (DGF) and graft loss. [17][18][19][20] We have previously shown that the effect of CIT on outcomes after kidney transplantation is more pronounced among HIV + recipients compared with their HIV 2 counterparts. 21 These findings motivate a focus in clinical practice to reduce CIT in HIV + recipients.…”

Section: Study Populationmentioning

confidence: 99%

A National Study of Outcomes among HIV-Infected Kidney Transplant Recipients

Locke

Mehta

Reed

et al. 2015

Journal of the American Society of Nephrology

119

125

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“…Most frequently defined as the requirement for dialysis during the first week after transplantation, it has been associated with short-and longterm adverse outcomes including decreased graft function and decreased graft and patient survival (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Absence of immediate function complicates the recipient's peritransplant management including the choice of an immunosuppression strategy.…”

Section: Introductionmentioning

confidence: 99%

Sirolimus Prolongs Recovery from Delayed Graft Function After Cadaveric Renal Transplantation

McTaggart

Gottlieb

Brooks

et al. 2003

American Journal of Transplantation

163

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Sirolimus, lacking known nephrotoxicity, appeared to be an ideal immunosuppressive agent in the setting of delayed graft function (DGF) after renal transplantation. Coincident with our use of sirolimus however, we noticed prolongation of DGF. To investigate possible causes of prolonged DGF, extensive donor, recipient, transplant, and post-transplant data were collected on 132 consecutive cases of DGF at the University of California, San Francisco between 1/1/97 and 6/30/01. Cox proportional hazards analysis of time to graft function was used in univariate and multivariate models to identify factors that prolong DGF. Sirolimus had a large and highly significant effect on time to graft function (hazard ratio 0.48, p = 0.0007). The hazard ratio indicates that a recipient on sirolimus is half as likely to resolve DGF or twice as likely to remain on dialysis as a recipient without sirolimus. Two other factors had less potent but still significant association with DGF duration: recipient sensitization (hazard ratio 0.66, p = 0.037), and Novartis score (hazard ratio 0.93 per 1.0 increase; p = 0.034). Sirolimus retained its profound negative association with time to graft function in all multivariate models. Because sirolimus appears to prolong DGF, it may not be the optimal immunosuppressive choice in the DGF setting.

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Delayed Graft Function, Acute Rejection, and Outcome After Cadaver Renal Transplantation

Cited by 469 publications

References 0 publications

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

Serial Protocol Biopsies to Quantify the Progression of Chronic Transplant Nephropathy in Stable Renal Allografts

A National Study of Outcomes among HIV-Infected Kidney Transplant Recipients

Sirolimus Prolongs Recovery from Delayed Graft Function After Cadaveric Renal Transplantation

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