Kidney Transplantation: Which Variables Should Be Improved?

Guedes-Marques, Maria; Romãozinho, Catarina; Santos, Lídia; Macário, Fernando; Alves, Rui; Mota, A.

doi:10.1016/j.transproceed.2015.03.023

Cited by 6 publications

(8 citation statements)

References 36 publications

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“…Relevant renal allograft fibrosis was detected in biopsy specimens, which is presumably not a result of renal damage following transplantation, but represents preexisting changes of the donor kidney. The correlation of diffusion parameters with allograft fibrosis found in our study supports the findings from experimental studies and clinical studies in patients with chronic kidney disease that renal allograft fibrosis is associated with ADC as well as FA reduction. Repetitive functional MRI with DWI and DTI might be useful to monitor the development of renal fibrosis noninvasively before overt loss of allograft function occurs.…”

Section: Discussionsupporting

confidence: 90%

“…In experimental studies it has been shown that ADC and FA negatively correlate with the amount of cell infiltration and the degree of interstitial renal fibrosis . A negative correlation of ADC values with interstitial fibrosis has been confirmed in patients with chronic kidney disease . Studies in patients with heterogeneous time intervals following kidney transplantation demonstrated reduced FA, ADC, as well as IVIM parameters in renal allografts with reduced function and a correlation of diffusion parameters with the severity of functional impairment …”

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confidence: 89%

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Diffusion‐Weighted imaging and diffusion tensor imaging detect delayed graft function and correlate with allograft fibrosis in patients early after kidney transplantation

Hueper

Khalifa

Bräsen

et al. 2016

Magnetic Resonance Imaging

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 89%

Diffusion‐Weighted imaging and diffusion tensor imaging detect delayed graft function and correlate with allograft fibrosis in patients early after kidney transplantation

Hueper

Khalifa

Bräsen

et al. 2016

Magnetic Resonance Imaging

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“…Changes in Hb may represent perioperative insult, particularly intraoperative bleeding in conjunction with hemodilution due to excessive intravenous fluid administration. Our findings support the hypothesis of Guedes-Marques, et al [ 18 ], that perioperative changes in hemoglobin concentration may serve as a novel modifiable factor of PEGF in patients undergoing deceased donor kidney transplant.…”

Section: Main Textsupporting

confidence: 91%

Perioperative hemoglobin decrement as an independent risk of poor early graft function in kidney transplantation

et al. 2020

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Objective: Perioperative change of hemoglobin concentration (Hb) was associated with acute kidney injury in patients who underwent non-cardiac surgery, but has never been investigated in kidney transplant patients. This study aimed to observe the effects of perioperative Hb change on early graft function in kidney transplant recipients. Results: A total of 269 kidney transplant patients were enrolled, of whom 98 (36.4%) developed poor early graft function (PEGF), and 171 (63.6%) had immediate graft function. Comparing two groups, patients with PEGF had a greater decremental change of Hb (−1.60 [−2.38,−0.83] vs. −0.70 [−1.35,0.20] g/dL, respectively; p < 0.001). A Hb cut-point of −1.35 g/dL was obtained from ROC analysis. Multivariate analysis showed that perioperative Hb decrement greater than 1.35 g/dL was an independent risk of PEGF (adjusted OR of 2.52, 95% CI 1.11-5.72; p = 0.026). Subgroup analysis revealed deceased donor kidney transplant (DDKT; n = 126) (adjusted OR of 2.89, 95% CI 1.11-7.55; p = 0.029), but not living donor kidney transplantation (LDKT; n = 143) (adjusted OR of 1.68, 95% CI 0.23-12.15; p = 0.606), was influenced by the perioperative Hb decrement. In conclusion, this study suggests that decremental change in perioperative Hb greater than 1.35 g/dL may serve as a modifiable factor of PEGF in DDKT.

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“…20 Other studies also contradict our findings as they suggest that pre-transplant hypoalbuminemia is associated with increased rates of adverse outcomes. 3,21 In a large study by Molnar et al, pre-transplant hypoalbuminemia was associated with a greater risk of DGF, all-cause and cardiovascular mortality, and graft loss. 22 This study has the limitation of being a single-center study with protocols that may not reflect those of other centers, and regional and patient population biases.…”

Section: Discussionmentioning

confidence: 99%

Pre‐transplant hypoalbuminemia is not associated with worse short‐term outcomes among kidney transplant recipients

Breyer

Astor

Srivastava

et al. 2022

Clinical Transplantation

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Introduction Serum albumin is an indicator of overall health status, but it remains unclear how pre‐transplant hypoalbuminemia is associated with early post‐transplant outcomes. Methods This study included all adult kidney transplant recipients (KTRs) at our center from 01/01/2001–12/31/2017 with serum albumin measured within 30 days before transplantation. KTRs were grouped based on pretransplant albumin level normal (≥4.0 g/dL), mild (≥3.5 – < 4.0g/dL), moderate (≥3.0 – < 3.5g/dL), or severe hypoalbuminemia (<3.0g/dL). Outcomes of interest included: length of hospital stay (LOS), readmission within 30 days, delayed graft function(DGF), and re‐operation related to post‐transplant surgical complications. We also analyzed rejection, graft failure, and death within 6 months post‐transplant. Results A total of 2807 KTRs were included 43.6% had normal serum albumin, 35.3% mild, 16.6% moderate, and 4.5% severe hypoalbuminemia. Mild and moderate hypoalbuminemia were associated with a shorter LOS by 1.22 (p < 0.001) and 0.80 days (p = 0.01), respectively, compared to normal albumin. Moderate (HR: 0.58; 95% CI: 0.37‐0.91; p = 0.02) and severe hypoalbuminemia (HR: 0.21; 95% CI: 0.07–0.68; p = 0.01) were associated with significantly lower rates of acute rejection within 6 months post‐transplant. Conclusion Patients with pre‐transplant hypoalbuminemia have post‐transplant outcomes similar to those with normal serum albumin, but with a lower risk of acute rejection based on the degree of hypoalbuminemia.

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Kidney Transplantation: Which Variables Should Be Improved?

Cited by 6 publications

References 36 publications

Diffusion‐Weighted imaging and diffusion tensor imaging detect delayed graft function and correlate with allograft fibrosis in patients early after kidney transplantation

Diffusion‐Weighted imaging and diffusion tensor imaging detect delayed graft function and correlate with allograft fibrosis in patients early after kidney transplantation

Perioperative hemoglobin decrement as an independent risk of poor early graft function in kidney transplantation

Pre‐transplant hypoalbuminemia is not associated with worse short‐term outcomes among kidney transplant recipients

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