Poor early graft function impairs long-term outcome in living donor kidney transplantation

Hellegering, Joyce; Visser, Jelle; Kloke, H. J.; d’Ancona, Frank; Hoitsma, Andries J.; Vliet, J. Adam van der; Warlé, Michiel C.

doi:10.1007/s00345-012-0835-z

Cited by 35 publications

(36 citation statements)

References 14 publications

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“…Furthermore, the long-term graft survival rates have been shown to be significantly lower compared to those patients with immediate graft function. Hellegering et al [5] showed that BMI, pre-transplant dialysis and warm ischemia time are associated with slow graft function on a multivariate analysis, and therefore, a meticulous selection of the donors and a short warm ischemia time should always be attempted. Following this direction, there have been multiple studies addressing the prevention of ischemia and posterior reperfusion injury in living donor nephrectomy.…”

mentioning

confidence: 99%

Editorial for a special issue on kidney transplant

Faba

Breda

2013

World J Urol

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mentioning

confidence: 99%

Editorial for a special issue on kidney transplant

Faba

Breda

2013

World J Urol

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“…Recurrent disease will appear in the chronic setting, rather than acute rejection [54,55]. Recurrence of both focal glomerulosclerosis and membranoproliferative glomerulonephritis is more frequent in the pediatric population [56].…”

Section: Resultsmentioning

confidence: 99%

Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

Khater

Khauli²

2012

Urol Int

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Objectives: Multiple factors may result in an elevation in serum creatinine level after kidney transplantation, mimicking rejection. It is crucial to differentiate between a true rejection and other conditions inducing a ‘pseudorejection', in order to avoid overtreatment, or worse, mistreatment. Our goal was to review and classify true rejections and pseudorejections and their clinical significance. Material and Methods: This was a retrospective review of articles published in the USA and Europe, from 1976 to the present. The sites from which information was retrieved included PubMed, Clinical Imaging, Histopathology, Archives of Surgery, JACS, the American Urological Association, Medline and Springer Link. The importance of the resistive index will also be emphasized. Results: We reviewed 61 articles regarding the causes of renal graft dysfunction, which may be classified into true rejections and pseudorejections, the latter including the following 6 factors: hyperglycemia, ureteral obstruction, lymphocele, arterial stenosis, infection and recurrence of primary pathology. Conclusions: ‘Pseudorejection' has been described only once, for the first time in 1976 in the USA, and there have been no other reports since then. Multiple factors, mainly hyperglycemia, may induce a pseudorejection, presenting with an elevation of serum creatinine level and leading the clinician to an erroneous diagnosis of true rejection initially, resulting in inappropriate management.

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“…The rate of resumption of graft function does not affect long-term survival as much as a delay in function. 8 In a retrospective study of graft survival that excluded patient deaths (n = 472 transplant recipients), Hellegering and associates 23 reported that the difference in death-censored survival rates between patients with DGF and normal graft function resulted in an adjusted hazard ratio of 6 24 Understanding the reason for the persistently close relation between graft survival and DGF warrants further study and a need to formulate further modalities for the optimal treatment of DGF after transplant.…”

Section: Effects Of Delayed Graft Function On Outcomes Of Living-donomentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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With an increased incidence of living-donor kidney transplants, in response to increasing unmet needs for renal transplant, a clear understanding of determinants of posttransplant outcomes is essential. The importance of delayed graft function in deceased-donor kidney transplant is now part of conventional medical wisdom, due to the large amount of evidence focused on this aspect. However, the same is not true for living-donor kidney transplant, partly due to lack of evidence on this crucial clinical question and partly due to lack of awareness about this issue. The current review aims to highlight the importance of delayed graft function as a crucial determinant of outcomes in living-donor kidney transplant. An exhaustive search of online medical databases was performed with appropriate search criteria to collect evidence about delayed graft function after living-donor kidney transplant, with a special focus on studies from the Middle East. Data on incidence, impact, risk factors, and possible prevention modalities of delayed graft function in patients undergoing living-donor kidney transplant are presented. A key finding of this review is that contemporary incidence rates reported from the Middle East are comparatively higher than those reported from outside the region. Although in absolute terms the incidence is lower than deceaseddonor kidney transplant, the effects of delayed graft function on graft rejection and graft and patient survival are sufficiently large to warrant the formulation of specific treatment protocols. Key to formulating prevention and treatment strategies is identifying discrete risk factors for delayed graft function. Although this evidence is scant, an overview has been provided. Further studies examining different aspects of delayed graft function incidence after living-donor kidney transplant are urgently needed to address a so far little known clinical question.

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Poor early graft function impairs long-term outcome in living donor kidney transplantation

Cited by 35 publications

References 14 publications

Editorial for a special issue on kidney transplant

Editorial for a special issue on kidney transplant

Pseudorejection and True Rejection after Kidney Transplantation: Classification and Clinical Significance

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