Delayed graft function in pediatric deceased donor kidney transplantation: Donor‐related risk factors and impact on two‐yr graft function and survival: A single‐center analysis

Cesca, Eleonora; Ghirardo, G; Kiblawi, Rim; Murer, Luisa; Gamba, Piergiorgio; Zanon, Giovanni Franco

doi:10.1111/petr.12252

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…Post-KAS recipients spent more time receiving dialysis (median 1.26 vs 1.07 years, P = .02), were more likely to have 100% cPRA (2.0% vs 0.1%, P = .001), and were equally like to have ≤3 mismatches with their donor (17.1% vs 16.1%, P = .5). Donor age increased slightly post-KAS (median [IQR] 22 years [18][19][20][21][22][23][24][25][26][27][28][29] vs 22 years [17][18][19][20][21][22][23][24][25][26][27], P < .001), and post-KAS recipients were less likely to receive an organ from a pediatric donor (22.6% vs 28.1%, P < .01). CIT was not significantly different between groups (median 11.6 vs 11.5 hours, P = .3), nor was KDPI (median 12 vs 11, P = .4).…”

Section: Study Populationmentioning

confidence: 99%

“…DGF is an important outcome to study because it is associated with worse posttransplant outcomes, including acute rejection and graft failure. [25][26][27][28] Moreover, it is a relatively more common complication after DDKT, such that any differences in its incidence after KAS should be readily apparent. Our finding of no statistically significant difference in DGF rates after KAS is in contrast to a study that reported a 69% increase in the odds of DGF for pDDKT recipients <10 years old.…”

Section: Ta B L Ementioning

confidence: 99%

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Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System

Jackson

Zhou

Ruck

et al. 2019

American Journal of Transplantation

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The Kidney Allocation System (KAS) has resulted in fewer pediatric kidneys being allocated to pediatric deceased donor kidney transplant (pDDKT) recipients. This had prompted concerns that post‐pDDKT outcomes may worsen. To study this, we used SRTR data to compare the outcomes of 953 pre‐KAS pDDKT (age <18 years) recipients (December 4, 2012–December 3, 2014) with the outcomes of 934 post‐KAS pDDKT recipients (December 4, 2014–December 3, 2016). We analyzed mortality and graft loss by using Cox regression, delayed graft function (DGF) by using logistic regression, and length of stay (LOS) by using negative binomial regression. Post‐KAS recipients had longer pretransplant dialysis times (median 1.26 vs 1.07 years, P = .02) and were more often cPRA 100% (2.0% vs 0.1%, P = .001). Post‐KAS recipients had less graft loss than pre‐KAS recipients (hazard ratio [HR]: 0.350.540.83, P = .005) but no statistically significant differences in mortality (HR: 0.290.721.83, P = .5), DGF (odds ratio: 0.931.321.93, P = .2), and LOS (LOS ratio: 0.961.061.19, P = .4). After adjusting for donor–recipient characteristics, there were no statistically significant post‐KAS differences in mortality (adjusted HR: 0.371.042.92, P = .9), DGF (adjusted odds ratio: 0.941.412.13, P = .1), or LOS (adjusted LOS ratio: 0.931.041.16, P = .5). However, post‐KAS pDDKT recipients still had less graft loss (adjusted HR: 0.380.590.91, P = .02). KAS has had a mixed effect on short‐term posttransplant outcomes for pDDKT recipients, although our results are limited by only 2 years of posttransplant follow‐up.

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Section: Study Populationmentioning

confidence: 99%

Section: Ta B L Ementioning

confidence: 99%

Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System

Jackson

Zhou

Ruck

et al. 2019

American Journal of Transplantation

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“…First, the true value of an allocation system is best measured with graft and patient survival, but it is too early to use these measures to assess the impact of KAS. Instead, we use DGF, a known surrogate for graft survival confirmed to be independently associated with graft failure in our sample, 9,10 Semiparametric decomposition of the increased odds of DGF post-KAS via the DiNardo, Fortin, and Lemieux method. This method uses a propensity score and inverse probability weighting to estimate the counterfactual outcome if post-KAS recipients had received kidneys from the same donors with the same amount of dialysis time as pre-KAS recipients.…”

Section: Study Limitationsmentioning

confidence: 99%

Impact of the kidney allocation system on young pediatric recipients

Parker

Ross

Thistlethwaite

et al. 2018

Clinical Transplantation

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The kidney allocation system (KAS) altered pediatric candidate prioritization. We determined KAS’s impact on pediatric kidney recipients by examining delayed graft function (DGF) rates from 2010 to 2016. A propensity score-matched pediatric recipients pre- and post-KAS. A semiparametric decomposition analysis estimated the contributions of KAS-related changes in donor characteristics and dialysis time on DGF rate. The unadjusted odds of DGF were 69% higher post-KAS for young (<10 years at listing) recipients (N = 1153, P = .02) but were not significantly increased for older pediatric (10-17 years at listing) recipients (N = 2624, P = .48). Post-KAS, young recipients received significantly fewer pediatric (<18 years) donor kidneys (21% vs 32%, P < .01) and had longer median pretransplant dialysis time (603 vs 435 days, P < .01). After propensity score matching, post-KAS status increased the odds of DGF in young recipients 71% (OR 1.71, 95% CI 1.01-2.46). In decomposition analysis, 24% of the higher DGF rate post-KAS was attributable to donor characteristics and 19% to increased recipient dialysis time. In a confirmatory survival analysis, DGF was associated with a 2.2 times higher risk of graft failure (aHR2.28, 95% CI 1.46-3.54). In conclusion, KAS may lead to worse graft survival outcomes in children. Allocation changes should be considered.

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“…8 In adults, the most important DGF risk factors include cold ischemic time (CIT), 3,[9][10][11][12][13][14] warm ischemic time (WIT), 3,14 donor age, 3,10,13 donor BMI, 3 recipient size/age, 3,10,15,16 length of prior dialysis, 10 terminal serum creatinine (SCr), 3,12 and kidney donation after circulation death kidney. 3 There are comparatively very few reports that delineate DGF risk factors in children, but they include prolonged CIT, 14,17 increased donor age 18 and primary FSGS diagnosis. 19 DGF is associated with poorer graft function, acute rejection, graft failure, and death, 2,3,5,6,17,18 and these risks are accentuated with longer DGF duration.…”

Section: Introductionmentioning

confidence: 99%

“…3 There are comparatively very few reports that delineate DGF risk factors in children, but they include prolonged CIT, 14,17 increased donor age 18 and primary FSGS diagnosis. 19 DGF is associated with poorer graft function, acute rejection, graft failure, and death, 2,3,5,6,17,18 and these risks are accentuated with longer DGF duration. 4,20,21 However, the incidence of DGF in children after transplant is relatively low (4-10%).…”

Section: Introductionmentioning

confidence: 99%

Clinical indicators of slow graft function and outcome after pediatric kidney transplantation

Bajaj

Gershony

Afshar

et al. 2022

Pediatric Transplantation

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Background Lesser degrees of perioperative ischemia–reperfusion injury that does not require dialysis may nonetheless influence allograft outcomes, necessitating evaluation of suitable surrogate indicators of perioperative allograft injury. Methods This retrospective analysis of pediatric kidney transplants evaluated two indicators representing pace and completeness of recovery, for association with 12‐month estimated glomerular filtration rate (eGFR) and first‐year rate of eGFR decline: time to creatinine nadir (TTN) and ratio of recipient/donor unadjusted GFR (uGFRR/D) at 1‐month post‐transplant. Donor, recipient, and perioperative risk factors were tested further for association with these 2 indicators. Results 179 patients (190 transplants) aged 13 (IQR 7–17) years and 56% male were included. Twelve‐month eGFR was strongly associated with unadjusted GFR at 1 month (uGFR1M, p < .001) and uGFRR/D (p = .003), but not with TTN. None of the indicators was associated with the rate of subsequent eGFR decline after 1‐month post‐transplant. As a potential surrogate indicator, uGFR1M is effectively modeled by TTN and uGFRR/D (adjusted R2 = 0.57) and is associated with 12‐month eGFR (β = 0.81 ± 0.08; p < .001). Clinical factors associated with uGFRR/D included donor uGFR (p < .001), BSA (p = .026), age (p = .074), and recipient BSA (p < .001). Factors associated with pace of recovery (TTN) included donor uGFR (p = .018), type (p = .019), and recipient BSA (p = .022). Conclusions The uGFRR/D ratio, but not TTN, is a useful indicator of perioperative allograft damage that is associated with one‐year functional outcome; and uGFR1M is a potential early surrogate outcome. Donor, recipient, and perioperative factors that are associated with slow allograft function are identified.

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Delayed graft function in pediatric deceased donor kidney transplantation: Donor‐related risk factors and impact on two‐yr graft function and survival: A single‐center analysis

Cited by 6 publications

References 31 publications

Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System

Pediatric deceased donor kidney transplant outcomes under the Kidney Allocation System

Impact of the kidney allocation system on young pediatric recipients

Clinical indicators of slow graft function and outcome after pediatric kidney transplantation

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