Delayed Graft Function After Renal Transplantation: An Unresolved Problem

Martínez, Eva Gavela; Mateu, L.M. Pallardó; Calabuig, Asunción Sancho; Catalán, Sandra Beltrán; Berga, J. Kanter; Bernabeu, Ana Isabel Avila; Albiach, J. Crespo

doi:10.1016/j.transproceed.2011.06.051

Cited by 30 publications

(20 citation statements)

References 7 publications

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“…Although six factors influenced graft failure in our study in univariate analysis (Table ), DGF and donor GFR of ≤30 mL/min/1.73 m 2 were the only two independent predictive factors for graft failure in multivariate analysis. DGF and donor GFR have been previously reported to be associated with graft and patient survival . As our data are derived from registry data, we are not aware of the circumstances surrounding the decision to proceed with a transplant when the kidney allograft had marginal function.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and predictive factors of pediatric kidney transplants: An analysis of the Thai Transplant Registry

Rianthavorn

Kerr

Lumpaopong

et al. 2013

Pediatric Transplantation

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As universal coverage for pediatric kidney transplantation (KT) was introduced in Thailand in 2008, the number of recipients has been increasing. We evaluated predictive factors for graft failure to understand how to improve clinical outcomes in these children. Using data obtained from the National Transplant registry, we assessed the risk of graft failure using the Kaplan-Meier method and Cox proportional hazards regression. Altogether, 201 recipients aged <21 yr at the time of KT were studied. Living donors (LD) were significantly older than deceased donor (DD). Mean cold ischemia time of DD was 17 h. The mean donor glomerular filtration rate (GFR) was 84.0 mL/min/1.73 m(2) . Induction immunosuppressive therapy was administered more frequently in DD than in LDKT. Delayed graft function (DGF) occurred in 36 transplants. Over 719 person years of follow-up, 42 graft failures occurred. Graft survival at one, three, and five yr post-transplant were 95%, 88% and 76%, respectively. Two factors independently predicted graft failure in multivariate analysis. The hazard ratios for graft failure in patients with DGF and in patients with donor GFR of ≤30 mL/min/1.73 m(2) were 2.5 and 9.7, respectively. Pediatric recipients should receive the first priority for allografts from young DD with a good GFR, and DGF should be meticulously prevented.

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Section: Discussionmentioning

confidence: 99%

Outcomes and predictive factors of pediatric kidney transplants: An analysis of the Thai Transplant Registry

Rianthavorn

Kerr

Lumpaopong

et al. 2013

Pediatric Transplantation

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“…Despite its limitations, body mass index (BMI) is the most widely used marker of obesity and has been thoroughly studied regarding DGF, but results remain controversial. Data from studies including only patients who received a graft from a deceased donor indicated that the incidence of DGF was greater in patients with higher BMI , whereas the likelihood of DGF increased by 8.7% per BMI unit according to Weissenbacher et al . .…”

Section: Introductionmentioning

confidence: 99%

Exploring associations between anthropometric indices and graft function in patients receiving renal transplant

Tsirigoti

Kontogianni

Darema

et al. 2014

J Human Nutrition Diet

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Background The aim of the present study was to identify indicators of malnutrition, as obtained by anthropometric measurements, that might be potential predictors of transplant outcomes. Methods One hundred and three patients receiving a graft from a living or a deceased donor were included in this prospective study. Body mass index (BMI) based on pretransplant dry body weight, triceps skinfold, mid‐arm muscle circumference and corrected mid‐arm muscle area were measured. Post‐transplant data on delayed graft function (DGF) and glomerular filtration rate (GFR) at discharge were collected until patient discharge. Results Delayed graft function developed in 36.9% of the patients. BMI was the only anthropometric variable associated with a higher likelihood of DGF (odds ratio = 1.25, 95% confidence interval = 1.07–1.47) after adjusting for age, gender, donor group, donor age and years of dialysis before transplantation. Obesity was associated with a higher frequency of DGF (83.3% versus 31.1%, P = 0.001) compared to normal weight. GFR at discharge was negatively associated with BMI [β = −0.014 (0.005), P = 0.004], being overweight [β = −0.151 (0.041), P < 0.001] and obesity [β = −0.188 (0.053), P = 0.001], after adjusting for age, gender, donor group, donor age and years of dialysis, but was not associated with indices of muscle reserves. Conclusions The likelihood of DGF was higher among obese patients, whereas GFR at discharge was negatively associated with being overweight and obesity.

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“…Brazilian studies have reported incidences of delayed graft function (DGF) between 50 and 70%, 2 to 3-fold higher than the rates described by American and European cohorts, despite similar or more favorable recipient and donor demographics [1][2][3][4][5][6]. A Brazilian study reported 22.7% incidence of delayed kidney function in a cohort of simultaneous pancreas-kidney transplants, despite a short mean cold ischemia time of 14h and the use of ideal donors [7].…”

Section: Introductionmentioning

confidence: 99%

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

et al. 2020

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BackgroundThis study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. MethodsA total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. ResultsMost patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, � 1 or high dose vasopressors and blood glucose.

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Delayed Graft Function After Renal Transplantation: An Unresolved Problem

Cited by 30 publications

References 7 publications

Outcomes and predictive factors of pediatric kidney transplants: An analysis of the Thai Transplant Registry

Outcomes and predictive factors of pediatric kidney transplants: An analysis of the Thai Transplant Registry

Exploring associations between anthropometric indices and graft function in patients receiving renal transplant

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

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