Intermediate Early Graft Function Is Associated With Increased Incidence of Graft Loss and Worse Long-Term Graft Function in Kidney Transplantation

Raimundo, Mário; Guerra, J.; Teixeira, Catarina; Santana, Alice; Silva, S.; Homens, C.M.; Costa, António Gomes da

doi:10.1016/j.transproceed.2013.02.013

“…Even though DGF is broadly considered a harmful condition with a significant negative impact on graft and patient survival [18][19][20][21][22], its relationship with hypotension is debated.…”

Section: Plos Onementioning

confidence: 99%

Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

Dolla

¹

,

Mella

²

,

Vigilante

³

et al. 2021

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Background Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive. Methods A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003–2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). Results Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor. Conclusions Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.

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“…Delayed graft function (DGF) indicates that a desirable level of kidney function has not been achieved within a certain time after kidney transplantation [1]. The risk of rejection and graft loss is higher for DGF than for early graft function (EGF) [2][3][4]. The reported incidence of DGF has varied from 3% to 50%, and the rate is rising because of the expansion of the donor pool [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Intravoxel Incoherent Motion-Diffusion-Weighted MRI for Investigation of Delayed Graft Function Immediately after Kidney Transplantation

Chang

¹

,

Tsai

²

,

Chung

³

et al. 2022

BioMed Research International

2

0

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Purpose. A non-invasive way of assessing post-transplant renal graft function has been needed. This study aimed to assess the micro-structural and micro-functional status of graft kidneys by using intravoxel incoherent motion- (IVIM-) diffusion-weighted imaging (DWI) to investigate delayed graft function (DGF) immediately after transplantation. Method. A prospective study was conducted on 37 patients, 14 with early graft function (EGF) and 23 with DGF (9 with complication, 14 without) who underwent IVIM-DWI, most often within 1-7 days after kidney transplantation. A total of 37 cases were collected and all the participants have been well-informed and signed their consents. In addition, the study conducted in this paper was approved by the Ethics Committee of Clinical Research, Taichung Veterans General Hospital (IRB number: CE14065). Using biexponential analysis of slow diffusion coefficient ( D slow ), fast diffusion coefficient ( D fast ), and perfusion fraction was performed. The apparent diffusion coefficient ( ADC ) was calculated by use of a monoexponential model. All parameters were measured from three different regions-of-interest (ROI), covering the entire renal parenchyma, cortex, and medulla. Results. D slow , perfusion fraction, and ADC were significantly higher in patients with EGF than DGF (all p values values <0.001). Especially, ADC measured from ROI covering the entire kidney parenchyma had the best cut-off value (1.93μm2/msec) with the highest area under the receiver operating characteristic curve ( AUC 0.943) in differentiating EGF from DGF. For analysis of pair-wise differences, only the perfusion fraction values, measured from the ROI covering the renal cortex, were significantly higher in 14 DGF patients with no complications than in the 9 DGF patients with complications, with the best cut-off value of 12.3% and the AUC of 0.844. Conclusion. Noninvasive IVIM-DWI reliably differentiates DGF from EGF after kidney transplantation, and it may aid in identifying posttransplant complications and indications for renal biopsy.

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“…In contrast, the renal allograft may be damaged. An impaired renal allograft function within the first weeks or within the first year is detrimental to the longevity of the allograft and accounts for a 40% decrease in long-term graft survival [1] – [5] . A major role of ischemia-reperfusion injury for impaired renal allograft function has been confirmed in the literature [6] .…”

Section: Introductionmentioning

confidence: 99%

Urinary Calprotectin and Posttransplant Renal Allograft Injury

Tepel

¹

,

Borst

²

,

Bistrup

³

et al. 2014

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ObjectiveCurrent methods do not predict the acute renal allograft injury immediately after kidney transplantation. We evaluated the diagnostic performance of urinary calprotectin for predicting immediate posttransplant allograft injury.MethodsIn a multicenter, prospective-cohort study of 144 incipient renal transplant recipients, we postoperatively measured urinary calprotectin using an enzyme-linked immunosorbent assay and estimated glomerular filtration rate (eGFR) after 4 weeks, 6 months, and 12 months.ResultsWe observed a significant inverse association of urinary calprotectin concentrations and eGFR 4 weeks after transplantation (Spearman r = −0.33; P<0.001). Compared to the lowest quartile, patients in the highest quartile of urinary calprotectin had an increased risk for an eGFR less than 30 mL/min/1.73 m2 four weeks after transplantation (relative risk, 4.3; P<0.001; sensitivity, 0.92; 95% CI, 0.77 to 0.98; specificity, 0.48; 95% CI, 0.31 to 0.66). Higher urinary calprotectin concentrations predicted impaired kidney function 4 weeks after transplantation, as well as 6 months and 12 months after transplantation. When data were analyzed using the urinary calprotectin/creatinine-ratio similar results were obtained. Urinary calprotectin was superior to current use of absolute change of plasma creatinine to predict allograft function 12 months after transplantation. Urinary calprotectin predicted an increased risk both in transplants from living and deceased donors. Multivariate linear regression showed that higher urinary calprotectin concentrations and older donor age predicted lower eGFR four weeks, 6 months, and 12 months after transplantation.ConclusionsUrinary calprotectin is an early, noninvasive predictor of immediate renal allograft injury after kidney transplantation.

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Intermediate Early Graft Function Is Associated With Increased Incidence of Graft Loss and Worse Long-Term Graft Function in Kidney Transplantation

Cited by 7 publications

References 7 publications

Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

Intravoxel Incoherent Motion-Diffusion-Weighted MRI for Investigation of Delayed Graft Function Immediately after Kidney Transplantation

Urinary Calprotectin and Posttransplant Renal Allograft Injury

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