Delayed Graft Function Does Not Reduce the Survival of Renal Transplant Allografts

Marcén, R.; Orofino, L.; Pascual, Julio; Cal, Miguel A. de la; Teruel, J.L.; Villafruela, J.J.; Rivera, María Dolores González; Mampaso, F; Burgos, Francisco; Ortuño, J

doi:10.1097/00007890-199808270-00008

Cited by 89 publications

(59 citation statements)

References 22 publications

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“…3,11,12 Although most studies agree that DGF is associated with poorer outcomes, multiple DGF definitions are used. [13][14][15][16][17] Current means of diagnosing DGF or SGF, using Scr and urine output (UOP), require knowledge of previous values to interpret, are affected by diuretic use, and can take a number of days to confirm. 18 As in other forms of acute kidney injury (AKI) caused by IRI, this lag in diagnosis has greatly hampered efforts to prevent or treat renal injury in human trials.…”

mentioning

confidence: 99%

IL-18 and Urinary NGAL Predict Dialysis and Graft Recovery after Kidney Transplantation

Hall¹,

Yarlagadda²,

Coca³

et al. 2010

Journal of the American Society of Nephrology

285

218

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Current methods for predicting graft recovery after kidney transplantation are not reliable. We performed a prospective, multicenter, observational cohort study of deceased-donor kidney transplant patients to evaluate urinary neutrophil gelatinase-associated lipocalin (NGAL), IL-18, and kidney injury molecule-1 (KIM-1) as biomarkers for predicting dialysis within 1 wk of transplant and subsequent graft recovery. We collected serial urine samples for 3 d after transplant and analyzed levels of these putative biomarkers. We classified graft recovery as delayed graft function (DGF), slow graft function (SGF), or immediate graft function (IGF). Of the 91 patients in the cohort, 34 had DGF, 33 had SGF, and 24 had IGF. Median NGAL and IL-18 levels, but not KIM-1 levels, were statistically different among these three groups at all time points. ROC curve analysis suggested that the abilities of NGAL or IL-18 to predict dialysis within 1 wk were moderately accurate when measured on the first postoperative day, whereas the fall in serum creatinine (Scr) was not predictive. In multivariate analysis, elevated levels of NGAL or IL-18 predicted the need for dialysis after adjusting for recipient and donor age, cold ischemia time, urine output, and Scr. NGAL and IL-18 quantiles also predicted graft recovery up to 3 mo later. In summary, urinary NGAL and IL-18 are early, noninvasive, accurate predictors of both the need for dialysis within the first week of kidney transplantation and 3-mo recovery of graft function.

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mentioning

confidence: 99%

IL-18 and Urinary NGAL Predict Dialysis and Graft Recovery after Kidney Transplantation

Hall¹,

Yarlagadda²,

Coca³

et al. 2010

Journal of the American Society of Nephrology

285

218

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“…The demographic characteristics of our population (Table 1) are associated with increased risk to develop DGF/ SGF and inferior short-and long-term transplant outcomes (11)(12)(13). The majority of the transplanted kidneys probably met the expanded donor criteria and 95% of the patients had been on dialysis for more than 24 months, risk factors independently associated with development of DGF (14,15) and with inferior renal transplant outcomes (5). The incidence and duration of DGF observed in this study stand out when compared to previous studies and with UNOS data (11,16).…”

Section: Discussionmentioning

confidence: 99%

Impact of initial exposure to calcineurin inhibitors on kidney graft function of patients at high risk to develop delayed graft function

Silva

Felipe

Park

et al. 2006

Braz J Med Biol Res

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We conducted a retrospective analysis of the influence of full doses of calcineurin inhibitors [8-10 mg kg -1 day -1 cyclosporine (N = 80), or 0.2-0.3 mg kg -1 day -1 tacrolimus (N = 68)] administered from day 1 after transplantation on the transplant outcomes of a high-risk population. Induction therapy was used in 13% of the patients. Patients also received azathioprine (2 mg kg -1 day -1 , N = 58) or mycophenolate mofetil (2 g/day, N = 90), and prednisone (0.5 mg kg -1 day -1 , N = 148). Mean time on dialysis was 79 ± 41 months, 12% of the cases were re-transplants, and 21% had panel reactive antibodies >10%. In 43% of donors the cause of death was cerebrovascular disease and 27% showed creatinine above 1.5 mg/dL. The incidence of slow graft function (SGF) and delayed graft function (DGF) was 15 and 60%, respectively. Mean time to last dialysis and to nadir creatinine were 18 ± 15 and 34 ± 20 days, respectively. Mean creatinine at 1 year after transplantation was 1.48 ± 0.50 mg/dL (DGF 1.68 ± 0.65 vs SGF 1.67 ± 0.66 vs immediate graft function (IGF) 1.41 ± 0.40 mg/dL, P = 0.089). The incidence of biopsy-confirmed acute rejection was 22% (DGF 31%, SGF 10%, IGF 8%). One-year patient and graft survival was 92.6 and 78.4%, respectively. The incidence of cytomegalovirus disease, post-transplant diabetes mellitus and malignancies was 28, 8.1, and 0%, respectively. Compared to previous studies, the use of initial full doses of calcineurin inhibitors without antibody induction in patients with SGF or DGF had no negative impact on patient and graft survival.

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“…5,9,10 • Need for dialysis during first 7 days after transplant once infection, rejection, and obstruction had been excluded. 12 …”

Section: Dialysis-based Definitionsmentioning

confidence: 99%

“…One recent systematic review identified 18 different definitions of DGF. 8 The most commonly used definition is "the need for dialysis in the first week after transplant" 9,10 ; however, a myriad of other descriptions exist based on either the need for dialysis, or creatinine and urine output trends. 8 We postulated that DGF may not be a single entity and that several patterns of DGF with different clinical significance may exist.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Aitken

Cooper²,

Dempster³

et al. 2015

Exp Clin Transplant

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Objectives: Delayed graft function is a significant prognostic indicator after renal transplantation. We hypothesized that delayed graft function is not a single entity, and different patterns of delayed graft function reflect various underlying pathological processes. Materials and Methods: An analysis of 762 renal transplants was performed, showing serum creatinine was charted serially for the first 30 days after transplant. Measurements were obtained: time on hemodialysis; time to peak creatinine; time for creatinine to half; time for creatinine to within 10% of baseline. Results: Four patterns of delayed graft function were identified. There was no association between pattern of delayed graft function, and 1-year graft survival or serum creatinine at 1 year. Time for creatinine to >15 days was associated with a higher creatinine level at 1 year than it was with patients with time for creatinine to half < 5 days (300.6 ± 54.3 vs 211.3 ± 26.0 μmol/L; P < .01). Patients with 1-year creatinine concentrations > 180 μmol/L had longer time on hemodialysis and time for creatinine to half than did those with 1-year creatinine concentrations ≤ 180 μmol/L (9.2 ± 1.3 μmol/L vs 7.0 ± 0.7 μmol/L; P = .03; and 11.6 ± 1.7 μmol/L vs 6.0 ± 0.4 μmol/L; P < .001). Time for creatinine to half of 6.5 days (sensitivity 67.3%; specificity 79.4%; area under the curve, 0.70) was the best predictor of a 1-year creatinine concentration ≤ 180 μmol/L. Conclusions:Delayed graft function is not a single entity; rather; it is the most common presentation of a heterogenous variety of pathologies. Its rate of resolution of renal function is the best predictor of long-term graft outcome.

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Delayed Graft Function Does Not Reduce the Survival of Renal Transplant Allografts

Cited by 89 publications

References 22 publications

IL-18 and Urinary NGAL Predict Dialysis and Graft Recovery after Kidney Transplantation

IL-18 and Urinary NGAL Predict Dialysis and Graft Recovery after Kidney Transplantation

Impact of initial exposure to calcineurin inhibitors on kidney graft function of patients at high risk to develop delayed graft function

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