Outcomes of Delayed Graft Function in Kidney Transplant Recipients Stratified by Histologic Biopsy Findings

Rolak, Stacey; Djamali, Arjang; Mandelbrot, Didier A.; Muth, Brenda; Jorgenson, Margaret R.; Zhong, Weixiong; Liu, Patricia; Astor, Brad C.

doi:10.1016/j.transproceed.2021.01.012

Cited by 12 publications

(12 citation statements)

References 28 publications

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“…17 In the same study, compared to those with ATN alone, recipients with acute rejection were more than three times as likely to have DCGF within the first year of transplant. 17 Unfortunately, DGF is also associated with lower quality of life. In one study, KTRs with DGF were observed to lose .87 quality life years.…”

Section: Discussionmentioning

confidence: 90%

“…DGF is associated with an increased incidence of acute rejection and is associated with poorer long‐term graft outcomes 16 . In one study, among 269 KTRs with DGF, who had undergone a kidney biopsy within 14 days of transplant, 29.4% had acute rejection (16.4% acute rejection only, and 13% acute rejection with acute tubular necrosis [ATN]) 17 . In the same study, compared to those with ATN alone, recipients with acute rejection were more than three times as likely to have DCGF within the first year of transplant 17 .…”

Section: Discussionmentioning

confidence: 99%

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In kidney recipients from the same deceased donor, discordance in delayed graft function is associated with the worst outcomes

Yousif

Muth

Manchala

et al. 2022

Clinical Transplantation

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Introduction: Delayed graft function (DGF) is a common complication among deceased donor kidney transplant recipients (DDKTs) and is associated with worse outcomes. The effect on outcomes of concordance versus discordance in DGF between two different recipients of kidneys from the same donor is largely unknown. Methods: We reviewed all adult DDKTs for which both kidneys were transplanted to two different recipients at our center between 2014-2019. DDKTs were divided into four groups based on the DGF status: concordance no DGF (cc-no-DGF); discordance no DGF(dd-no-DGF); discordance DGF (dd-DGF) and concordance in DGF (cc-DGF). Acute rejection (AR) and death censored graft failure (DCGF) were outcomes of interest.Results: A total of 578 DDKTs fulfilled our selection criteria, 280were in cc-no-DGF, 83 in dd-no-DGF, 83 in dd-DGF, and 132 in cc-DGF. Compared to cc-no-DGF, in univariate analysis, dd-DGF was associated with an increased risk of AR (HR: 1.60; 95% CI: 1.0-2.56) but cc-DGF was not (HR: 1.01; 95% CI: 0.63-1.62). dd-DGF was not associated with an increased risk of AR in multivariate analysis. In multivariate analysis, dd-DGF was associated with an increased risk of DCGF (HR: 2.70; 95% CI: 1.05-6.93) but cc-DGFwas not (HR: 2.36; 95% CI: 0.97-5.70). Conclusion:Discordance in DGF is associated with worse outcomes and may need closefollow-up and monitoring to improve the outcomes.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

In kidney recipients from the same deceased donor, discordance in delayed graft function is associated with the worst outcomes

Yousif

Muth

Manchala

et al. 2022

Clinical Transplantation

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“…DGF may have origins from a variety of diagnoses. While ATI is one of the known leading culprits, there are also other causes such as T cell-mediated rejection, antibody-mediated rejection, and acute calcineurin toxicity (Kers et al, 2018; Rolak et al, 2021). While it may not be possible to detect some recipient-related factors (such as rejection) or surgical causes (such as anastomosis) from histology, there may be subtle or localised acute lesions within small regions of some biopsies.…”

Section: Methodsmentioning

confidence: 99%

Predicting Clinical Endpoints and Visual Changes with Quality-Weighted Tissue-based Renal Histological Features

Tam

Soares

Kers

et al. 2022

Preprint

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Two common obstacles limiting the performance of data-driven algorithms in digital histopathology classification tasks are the lack of expert annotations and the narrow diversity of datasets. Multi-instance learning (MIL) can be used to address the former challenge for the analysis of whole slide images (WSI) but performance is often inferior to full supervision. We show that the inclusion of weak annotations can significantly enhance the effectiveness of MIL while keeping the approach scalable.An analysis framework was developed to process periodic acid-Schiff (PAS) and Sirius Red (SR) slides of renal biopsies. The workflow segments tissues into coarse tissue classes. Handcrafted and deep features were extracted from these tissues and combined using a soft attention model to predict several slide-level labels: delayed graft function (DGF), acute tubular injury (ATI), and Remuzzi grade components. A tissue segmentation quality metric was also developed to reduce the adverse impact of poorly segmented instances. The soft attention model was trained using 5-fold cross-validation on a mixed dataset and tested on the QUOD dataset containing n=373 PAS and n=195 SR biopsies.The average ROC-AUC over different prediction tasks was found to be 0.598±0.011, significantly higher than using only ResNet50 (0.545±0.012), only handcrafted features (0.542 ± 0.011), and the baseline (0.532 ± 0.012) of state-of-the-art performance. Weighting tissues by segmentation quality in conjunction with the soft attention has led to further improvement (AUC = 0.618 ± 0.010). Using an intuitive visualisation scheme, we show that our approach may also be used to support clinical decision making as it allows pinpointing individual tissues relevant to the predictions.

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“…If no improvement in graft function is noted within 7 to 14 d after transplantation, a kidney transplant biopsy is performed. 24,25 We follow our KTRs at the University Hospital or various outreach regional clinics. After discharge from an initial kidney transplant admission or discharge from the DGF clinic, patients are typically seen at posttransplant times of 3 wk, 6 wk, 3 mo, 6 mo, 9 mo, 12 mo, 18 mo, 24 mo, and then annually.…”

Section: Dgf and Regular Clinic Follow-upmentioning

confidence: 99%

Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia

Alshaikh,

Astor,

Muth

et al. 2023

Transplantation Direct

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Background. Delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs) is a well-known risk factor for allograft rejection, decreased graft survival, and increased cost. Although DGF is associated with an increased risk of rejection, it is unclear whether it also increases the risk of infection. Methods. We reviewed all adult DDKTRs at our center between 2010 and 2018. The primary outcomes of interest were BK viremia, cytomegalovirus viremia, pneumonia, and urinary tract infection (UTI) within the first year of transplant. Additional analysis was made with censoring follow-up at the time of allograft rejection. Results. A total of 1512 DDKTRs were included, of whom 468 (31%) had DGF. As expected, several recipient, donor, and baseline immunological characteristics differed by DGF status. After adjustment, DGF was significantly associated with an increased risk of BK viremia (hazard ratio: 1.34; 95% confidence interval, 1.0-1.81; P = 0.049) and UTI (hazard ratio: 1.70; 95% confidence interval, 1.31-2.19; P < 0.001) but not cytomegalovirus viremia or pneumonia. Associations were similar in models censored at the time of rejection. Conclusions. DGF is associated with an increased risk of early infectious complications, mainly UTI and BK viremia. Close monitoring and appropriate management are warranted for better outcomes in this unique population.

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Outcomes of Delayed Graft Function in Kidney Transplant Recipients Stratified by Histologic Biopsy Findings

Cited by 12 publications

References 28 publications

In kidney recipients from the same deceased donor, discordance in delayed graft function is associated with the worst outcomes

In kidney recipients from the same deceased donor, discordance in delayed graft function is associated with the worst outcomes

Predicting Clinical Endpoints and Visual Changes with Quality-Weighted Tissue-based Renal Histological Features

Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia

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