RETRACTED: Predictive Factors of Surgical Complications in the First Year Following Kidney Transplantation

Salamin, Pauline; Deslarzes-Dubuis, Céline; Longchamp, Alban; Petitprez, Séverine; Venetz, Jean-Pierre; Corpataux, Jean-Marc; Déglise, Sebastien

doi:10.1016/j.avsg.2021.08.031

Cited by 10 publications

(16 citation statements)

References 35 publications

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“…These vascular complications have been implicated in >60% of early graft loss. 49 Furthermore, all other perioperative complications studied were significantly associated with frailty, highlighting that these In our study, frailty was found to be associated with increased resource utilization, including longer duration of hospitalization, higher hospitalization costs, and greater likelihood of non-home discharge.…”

Section: Discussionsupporting

confidence: 53%

“…In addition, we found frail patients to demonstrate a two‐fold increase in odds of developing post‐transplantation renal artery and vein thrombosis. These vascular complications have been implicated in >60% of early graft loss 49 . Furthermore, all other perioperative complications studied were significantly associated with frailty, highlighting that these patients are at increased risk during the index admission.…”

Section: Discussionmentioning

confidence: 91%

“…Notably, prior literature has not examined the association of perioperative complications with frailty in the kidney transplant cohort. Ultimately, both timely identification and treatment of postoperative complications are crucial, as delayed intervention can jeopardize both graft and patient survival 49 . Bespoke care pathways for the frail should incorporate active surveillance and timely interventions in the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

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Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation

Mallick,

Sakowitz,

Bakhtiyar

et al. 2023

Clinical Transplantation

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IntroductionAlthough not formalized into current risk assessment models, frailty has been associated with negative postoperative outcomes in many specialties. However, national analyses of the association between frailty and post‐transplant outcomes following kidney transplantation (KT) are lacking.MethodsThis was a retrospective cohort study of adults undergoing KT from 2016 to 2020 in the Nationwide Readmissions Databases. Frailty was defined using the Johns Hopkins Adjusted Clinical Groups frailty indicator.ResultsOf an estimated 95 765 patients undergoing KT during the study period, 4918 (5.1%) were frail. After risk adjustment, frail patients were associated with significantly higher odds of in‐hospital mortality (AOR 2.17, 95% CI: 1.33–3.57) compared to their non‐frail counterparts. Our findings indicate that frail patients had an average increase in postoperative hospital stay of 1.44 days, a $2300 increase in hospitalization costs, as well as higher odds of developing a major perioperative complication as compared to their non‐frail counterparts. Frailty was also associated with greater adjusted risk of non‐home discharge.ConclusionsFrailty, as identified by administrative coding, is independently associated with worse surgical outcomes, including increased mortality and resource use, in adults undergoing KT. Given the already limited donor organ pool, novel efforts are needed to ensure adequate optimization and timely post‐transplantation care of the growing frail cohort undergoing KT.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation

Mallick,

Sakowitz,

Bakhtiyar

et al. 2023

Clinical Transplantation

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“…Lymphocele is associated with pain and reduced renal function. Higher incidences in obese than overweight and normal weight may necessitate ultrasound guided aspiration and reoperation to drain the large fluid collection to prevent the deterioration of KT function and infection [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Pretransplant BMI Significantly Affects Perioperative Course and Graft Survival after Kidney Transplantation: A Retrospective Analysis

Dobrzycka

Bzoma

Bieniaszewski

et al. 2022

JCM

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Background. The number of kidney transplant recipients (KTRs) with overweight and obesity is increasing. It was shown that obesity is related to inferior patient and graft survival. We aimed to analyze intraoperative parameters and postoperative short and long-term course of kidney transplantation (KT) in body mass index (BMI)-stratified cohorts of KTRs. Methods. A retrospective analysis of a prospectively built database of 433 KTRs from 2014 to 2017 from a single transplant center was performed. The objective of the study was to analyze the association between BMI at the time of transplantation with intraoperative parameters, adverse events in early postoperative course, and the overall mortality and graft loss in BMI-stratified cohorts: normal (18.5 and 24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Results. Obesity was related to longer total procedure time (p = 0.0025) and longer warm ischemia time (p = 0.0003). The postoperative course in obese patients was complicated by higher incidence of DGF (delayed graft function), early surgical complications (defined as surgical complications <30 days from KT), reoperation rate, vascular complications, incidence of lymphocele and wound dehiscence. There was no difference between the normal weight and overweight KTRs. The one-month kidney function (p = 0.0001) and allograft survival (p = 0.029) were significantly inferior in obese patients with no difference between normal weight and overweight patients. One-year death-censored graft survival was better in patients with BMI < 30 (88.6 vs. 94.8% p = 0.05). BMI was a significant predictor of graft loss in univariate (p = 0.04) but not in multivariate analysis (p = 0.09). Conclusion. Pretransplant obesity significantly affects the intraoperative and postoperative course of kidney transplantation and graft function and survival. The course of transplantation of overweight is comparable to normal BMI KTRs, and presumably pretransplant weight reduction to the BMI < 30 kg/m2 may improve the short-term postoperative course of transplantation as well as may improve graft survival. Thus, pretransplant weight reduction in obese KTRs may significantly improve the results of kidney transplantation. Metabolic surgery may play a role in improving results of KT.

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“…More than 25 000 kidney transplantation procedures were performed in 2021 compared to 17 107 transplantations in 2014 in the United States, the corresponding figures for 2019 and 2014 in Europe being 24 013 and 19 406 1–3 . Nevertheless, kidney transplantation is still associated with complications including acute/chronic rejection, vascular complications, infections, urinary leak, lymphocele, immunosuppressive drug‐associated events, post‐transplant malignancies, diabetes mellitus and hypertension 4–6 . Antibody‐mediated transplant rejection (AMR), commonly co‐exists with T‐cell‐mediated cellular rejection, representing a pathological spectrum accounting for up to 76% of death‐censored graft failures after the first year of transplantation with limited effectiveness of current therapeutic strategies 7,8 .…”

Section: Introductionmentioning

confidence: 99%

The role of anticomplement therapy in the management of the kidney allograft

Kanbay,

Copur,

Yilmaz

et al. 2024

Clinical Transplantation

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As the number of patients living with kidney failure grows, the need also grows for kidney transplantation, the gold standard kidney replacement therapy that provides a survival advantage. This may result in an increased rate of transplantation from HLA‐mismatched donors that increases the rate of antibody‐mediated rejection (AMR), which already is the leading cause of allograft failure. Plasmapheresis, intravenous immunoglobulin therapy, anti‐CD20 therapies (i.e., rituximab), bortezomib and splenectomy have been used over the years to treat AMR as well as to prevent AMR in high‐risk sensitized kidney transplant recipients. Eculizumab and ravulizumab are monoclonal antibodies targeting the C5 protein of the complement pathway and part of the expanding field of anticomplement therapies, which is not limited to kidney transplant recipients, and also includes complement‐mediated microangiopathic hemolytic anemia, paroxysmal nocturnal hemoglobinuria, and ANCA‐vasculitis. In this narrative review, we summarize the current knowledge concerning the pathophysiological background and use of anti‐C5 strategies (eculizumab and ravulizumab) and C1‐esterase inhibitor in AMR, either to prevent AMR in high‐risk desensitized patients or to treat AMR as first‐line or rescue therapy and also to treat de novo thrombotic microangiopathy in kidney transplant recipients.

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RETRACTED: Predictive Factors of Surgical Complications in the First Year Following Kidney Transplantation

Cited by 10 publications

References 35 publications

Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation

Administrative coding of frailty: Its association with clinical outcomes and resource use in kidney transplantation

Pretransplant BMI Significantly Affects Perioperative Course and Graft Survival after Kidney Transplantation: A Retrospective Analysis

The role of anticomplement therapy in the management of the kidney allograft

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