The Detrimental Effects of Delayed Graft Function in Cadaver Donor Renal Transplantation

Sanfilippo, Fred; Vaughn, William K.; Spees, Everett K.; Lucas, Bruce A.

doi:10.1097/00007890-198412000-00019

Cited by 159 publications

(52 citation statements)

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“…This hypothesis is supported by the finding that survival of kidney grafts coming from female compared with male donors is particularly poor in highly sensitized recipients (41). HLA matching does not completely abrogate the donor gender effect in first cadaver renal transplants and living related donor transplants (42,43). But a gender effect was demonstrable in our study, even in HLA-identical siblings, possibly pointing to an additional role of non-HLA factors.…”

Section: Discussioncontrasting

confidence: 60%

The Effect of Donor Gender on Graft Survival

Zeier¹,

Döhler

Opelz

et al. 2002

Journal of the American Society of Nephrology

226

163

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ABSTRACT. Differences in actuarial graft survival according to donor gender have been reported for renal allografts and for cardiac and hepatic allografts, but for the latter in small series with limited biostatistical power. Using the large database of the Collaborative Transplant Study (CTS), this study is an evaluation of graft survival according to donor and recipient gender for renal (n = 124,911), cardiac (n = 25,432), and hepatic (n = 16,410) transplants. Confounders, such as calendar year, geographical area, race, donor and recipient age, HLA mismatch, cold ischemia time, and others, as well as interaction terms were taken into consideration. Death-censored actuarial renal allograft survival from female compared with male donors was less in female recipients and even more so in male recipients. The donor gender-associated risk ratio for graft loss was 1.15 in female recipients and 1.22 in male recipients. The age-gender interaction term was statistically significant, the gender effect being more pronounced for younger (16 to 45 yr) compared with older (>45 yr) donors. Serum creatinine concentrations 1 yr after transplantation were also higher for recipients with kidney grafts coming from female donors irrespective of recipient gender. For first cardiac transplants, graft survival was inferior when the donor was female and the recipient male, but no statistical difference according to donor gender was demonstrable in female recipients. For first hepatic transplants overall, no significant differences according to donor gender were noted. The proportion of recipients who had treatment for rejection crisis during the first year was higher for male recipients of kidneys from female donors compared with male donors. No difference according to donor gender was demonstrable in female recipients. For cardiac and hepatic grafts, no significant effect of donor gender on the proportion of patients treated for rejection episodes was noted. The data show that adverse effects of female donor gender for different organs is much less uniform than reported in the past. An important confounder is donor age. A gender effect on graft survival is also observed for cardiac allografts. Therefore, in addition to potential “nephron underdosing,” further pathomechanisms must play a role, possibly differences in immunogenicity according to donor gender. E-mail: martin_zeier@med.uni-heidelberg.de

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Section: Discussioncontrasting

confidence: 60%

The Effect of Donor Gender on Graft Survival

Zeier¹,

Döhler

Opelz

et al. 2002

Journal of the American Society of Nephrology

226

163

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“…Most frequently defined as the requirement for dialysis during the first week after transplantation, it has been associated with short-and longterm adverse outcomes including decreased graft function and decreased graft and patient survival (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Absence of immediate function complicates the recipient's peritransplant management including the choice of an immunosuppression strategy.…”

Section: Introductionmentioning

confidence: 99%

Sirolimus Prolongs Recovery from Delayed Graft Function After Cadaveric Renal Transplantation

McTaggart

Gottlieb

Brooks

et al. 2003

American Journal of Transplantation

163

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Sirolimus, lacking known nephrotoxicity, appeared to be an ideal immunosuppressive agent in the setting of delayed graft function (DGF) after renal transplantation. Coincident with our use of sirolimus however, we noticed prolongation of DGF. To investigate possible causes of prolonged DGF, extensive donor, recipient, transplant, and post-transplant data were collected on 132 consecutive cases of DGF at the University of California, San Francisco between 1/1/97 and 6/30/01. Cox proportional hazards analysis of time to graft function was used in univariate and multivariate models to identify factors that prolong DGF. Sirolimus had a large and highly significant effect on time to graft function (hazard ratio 0.48, p = 0.0007). The hazard ratio indicates that a recipient on sirolimus is half as likely to resolve DGF or twice as likely to remain on dialysis as a recipient without sirolimus. Two other factors had less potent but still significant association with DGF duration: recipient sensitization (hazard ratio 0.66, p = 0.037), and Novartis score (hazard ratio 0.93 per 1.0 increase; p = 0.034). Sirolimus retained its profound negative association with time to graft function in all multivariate models. Because sirolimus appears to prolong DGF, it may not be the optimal immunosuppressive choice in the DGF setting.

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“…[10][11][12][13][14][15][16][17][18][19] The sensitivity and specificity of each DGF definition for predicting BPAR and graft loss at 1 year was obtained from standard formulae. A paired McNemar test was applied to compare these figures.…”

Section: Definitions Of Delayed Graft Functionmentioning

confidence: 99%

“…5,9,10 • Need for dialysis during first 7 days after transplant once infection, rejection, and obstruction had been excluded. 12 …”

Section: Dialysis-based Definitionsmentioning

confidence: 99%

“…One recent systematic review identified 18 different definitions of DGF. 8 The most commonly used definition is "the need for dialysis in the first week after transplant" 9,10 ; however, a myriad of other descriptions exist based on either the need for dialysis, or creatinine and urine output trends. 8 We postulated that DGF may not be a single entity and that several patterns of DGF with different clinical significance may exist.…”

Section: Introductionmentioning

confidence: 99%

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Aitken

Cooper²,

Dempster³

et al. 2015

Exp Clin Transplant

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Objectives: Delayed graft function is a significant prognostic indicator after renal transplantation. We hypothesized that delayed graft function is not a single entity, and different patterns of delayed graft function reflect various underlying pathological processes. Materials and Methods: An analysis of 762 renal transplants was performed, showing serum creatinine was charted serially for the first 30 days after transplant. Measurements were obtained: time on hemodialysis; time to peak creatinine; time for creatinine to half; time for creatinine to within 10% of baseline. Results: Four patterns of delayed graft function were identified. There was no association between pattern of delayed graft function, and 1-year graft survival or serum creatinine at 1 year. Time for creatinine to >15 days was associated with a higher creatinine level at 1 year than it was with patients with time for creatinine to half < 5 days (300.6 ± 54.3 vs 211.3 ± 26.0 μmol/L; P < .01). Patients with 1-year creatinine concentrations > 180 μmol/L had longer time on hemodialysis and time for creatinine to half than did those with 1-year creatinine concentrations ≤ 180 μmol/L (9.2 ± 1.3 μmol/L vs 7.0 ± 0.7 μmol/L; P = .03; and 11.6 ± 1.7 μmol/L vs 6.0 ± 0.4 μmol/L; P < .001). Time for creatinine to half of 6.5 days (sensitivity 67.3%; specificity 79.4%; area under the curve, 0.70) was the best predictor of a 1-year creatinine concentration ≤ 180 μmol/L. Conclusions:Delayed graft function is not a single entity; rather; it is the most common presentation of a heterogenous variety of pathologies. Its rate of resolution of renal function is the best predictor of long-term graft outcome.

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The Detrimental Effects of Delayed Graft Function in Cadaver Donor Renal Transplantation

Cited by 159 publications

References 0 publications

The Effect of Donor Gender on Graft Survival

The Effect of Donor Gender on Graft Survival

Sirolimus Prolongs Recovery from Delayed Graft Function After Cadaveric Renal Transplantation

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