Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

Wu, Wei; Famure, Olusegun; Li, Yanhong; Kim, S. Joseph

doi:10.1038/ki.2015.190

Cited by 174 publications

(155 citation statements)

References 36 publications

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“…We observed that more than 50% of patients with early aABMR experienced slow or delayed graft function, which was significantly higher compared with the 2 groups with late aABMR. This finding was matched with some reports denoting that slow and delayed graft function are risk factors for T-cell and antibodymediated rejection 19 and the combination of both can affect patient survival. 20,21 Most of our patients were young females, and this was explained by Dörje and associates 2 who found that most of their patients with rejection were young and nonadherent with suboptimal immuno suppression.…”

Section: Discussionsupporting

confidence: 85%

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Gheith

Al-Otaibi

Halim³

et al. 2017

Exp Clin Transplant

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Objectives: There are no comparable trials concerning the use of rituximab among renal transplant recipients with acute antibody-mediated rejection. Here, we compared early and late acute antibody-mediated rejection in renal transplant recipients in terms of response to rituximab therapy. Materials and Methods: Of 1230 kidney transplants performed at Hamed Al-Essa Organ Transplant Center (Kuwait) over the past 10 years, 103 recipients developed acute antibody-mediated rejections and were subcategorized into 4 groups according to the onset of rejection and rituximab treatment. All patients received the standard treatment for acute antibody-mediated rejection according to our protocol (plasma exchange and intravenous immunoglobulin). We added rituximab to the treatment regimen in 2 groups of patients: 27 patients with early rejection (group 1) and 38 patients with late rejection (group 2). Groups 3 and 4 represented nonrituximab groups, with 20 patients with early (group 3) and 18 patients with late rejection (group 4). We compared the 4 groups regarding graft and patient outcomes. Results: All patients were comparable regarding patient age, sex, pretransplant type of dialysis, viral profile, type of induction, donor criteria, and pretransplant comorbidities. We observed that delayed and slow graft function were significantly higher in groups 1 and 3 (P = .016); however, we found no significant differences in the 4 groups regarding new-onset diabetes after transplant, BK viral infection, and malignancy. Graft outcomes were significantly better in groups 1 and 2 than in groups 3 and 4 (P = .028). However, patient outcomes were comparable in the 4 groups (P > .05). Conclusions: Early acute antibody-mediated rejection in renal transplant recipients had significantly better outcomes when rituximab was added to the standard treatment regimen.

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Section: Discussionsupporting

confidence: 85%

Untitled

Gheith

Al-Otaibi

Halim³

et al. 2017

Exp Clin Transplant

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“…DGF can be viewed as a form of AKI following kidney transplantation, and has been associated with 40% higher risk of graft loss at one year posttransplant 3, increased susceptibility to acute and chronic rejection and poorer long‐term outcomes 4, 5. However DGF diagnosis can be complicated because there are several definitions based on a variety of clinical parameters 6.…”

Section: The Necessity Of Early Biomarkers In Acute Kidney Injury Andmentioning

confidence: 99%

Neutrophil Gelatinase‐Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights

et al. 2017

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Neutrophil gelatinase‐associated lipocalin (NGAL), a protein belonging to the lipocalin superfamily initially found in activated neutrophils, is expressed by several cell types, including kidney tubule. The increase in NGAL production and release from tubular cells in response to various insults has been proven to predict acute kidney injury (AKI). For this reason, it has emerged as a valuable noninvasive biomarker of AKI in clinical nephrology. Also in the renal transplant setting, different studies have indicated NGAL as a valuable tool, especially in the early postoperative period, since the currently available clinical and laboratory parameters remain poorly sensitive to monitor immediate posttransplant graft function. This is an analysis of the recent literature to assess the utility of plasma and urinary NGAL, exosomal mRNA for NGAL, and NGAL levels in the perfusate of machine‐perfused kidneys for the prediction of graft function recovery in the early postsurgery phase after renal transplantation. We found that NGAL appears as a promising troponin‐like biomarker to detect short‐term impairment of graft function after renal transplant, but there are still some limitations in its clinical application, essentially related to its low specificity. Moreover, comparing NGAL assayed in serum, urine, machine‐perfusate, or as exosomal mRNA, each one has shown limitations and benefits in terms of predictive performance for DGF, according to various existing studies, feasibly due to different cut‐off levels, designs and patient sample sizes.

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“…Despite substantial improvements in immunosuppressive therapies and surgical techniques, acute rejection (AR) remains a frequent and serious post-transplantation complication, which contributes to late allograft loss and mortality [3, 4]. To date, the gold standard for diagnosing AR relies on multiple and repeated renal allograft biopsies.…”

Section: Introductionmentioning

confidence: 99%

A Molecular Signature of Two Long Non-Coding RNAs in Peripheral Blood Predicts Acute Renal Allograft Rejection

Cao

et al. 2017

Cell Physiol Biochem

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Background/Aims: Acute rejection (AR) is a major complication post renal transplantation, with no widely-accepted non-invasive biomarker. This study aimed to explore the expression profiles of long non-coding RNAs (lncRNAs) in the peripheral blood (PB) of renal transplant recipients and their potential diagnostic values. Methods: The genome-wide lncRNA expression profiles were analyzed in 150 PB samples from pediatric and adult renal transplant (PRTx and ARTx) cohorts. The diagnostic performance of differentially expressed lncRNA was determined using receiver operator characteristic curve, with area under the curve (AUC) and 95% confidential interval (CI). Finally, a risk score was constructed with logistical regression model. Results: A total of 162 lncRNAs were found differentially expressed in PRTx cohort, while 163 in ARTx cohort. Among these identified lncRNAs, 23 deregulated accordingly in both cohorts, and could distinguish AR recipients from those without AR. Finally, a risk score with two most significant lncRNAs (AF264622 and AB209021) was generated and exhibited excellent diagnostic performance in both PRTx (AUC:0.829, 95% CI:0.735-0.922) and ARTx cohorts (AUC: 0.889, 95% CI: 0.817-0.960). Conclusion: A molecular signature of two lncRNAs in PB could serve as a novel non-invasive biomarker for the diagnosis of AR in both pediatric and adult renal transplant recipients.

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Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

Cited by 174 publications

References 36 publications

Untitled

Untitled

Neutrophil Gelatinase‐Associated Lipocalin as a Biomarker of Allograft Function After Renal Transplantation: Evaluation of the Current Status and Future Insights

A Molecular Signature of Two Long Non-Coding RNAs in Peripheral Blood Predicts Acute Renal Allograft Rejection

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