The effect of cold ischemia time on delayed graft function and acute rejection in kidney transplantation

Sert, İsmail; Çolak, Hülya; Tuğmen, Cem; Doğan, Murat; Karaca, Cezmi

doi:10.4103/1319-2442.139865

Cited by 25 publications

(27 citation statements)

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“…23,40,41 In a study by Simforoosh and associates 42 that compared graft and patient survival among patients who underwent KT from deceased-vs living donors, no significant difference in 1-year graft and patient survival between living and cadaver donor KT was found. It should be noted, however, that kidney removal and recipient transplant were coordinated in a way that cold ischemia time (CIT) was less than 3 hours.…”

Section: Discussionmentioning

confidence: 97%

Untitled

Stolyar

Budkar²,

Solodushkin³

et al. 2015

Exp Clin Transplant

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Objectives: We analyzed different donor characteristics to determine those that significantly affect patient and graft outcomes after kidney transplant. Materials and Methods:We conducted a retrospective analysis of patients who had received kidney transplants at our institution between 1990 and 2011 from deceased-donors. We tracked this patients until the end of 2014. Using univariate and multivariate analyses, we analyzed the following outcomes: patient status, graft status, chronic allograft nephropathy, and delayed graft function. Results: In 342 recipients, univariate analysis revealed donor-associated predictors of transplant outcomes. Recipients of kidneys from older donors showed longer time to creatinine normalization (P = .047). We found a partial correlation between donor diagnosis and the number of dialyses after surgery (excluding the effect of donor age), with patients receiving kidneys from donors who had cerebrovascular events having higher risk of delayed graft function (P = .03). Donors with shorter stays in intensive care units resulted in longer graft survival (P = .02), and vasopressor use by donors was associated with delayed graft function in recipients (P = .018). Low serum sodium levels in donors predicted worse survival of recipients and transplants (P = .015 and P = .048). The number of hemodialysis procedures after transplant was correlated with the donor's creatinine level (P = .027). Insufficient daily dieresis of donor predicted worse graft survival (P = .04). Correlation analysis showed that a higher P CO2 level in donors was significantly associated with longer creatinine normalization time after kidney transplant (P = .001). Cox regression analysis detected 2 significant independent predictors of graft outcomes: duration of perfusion of donor kidney (P = .016) and length of intensive care unit stay of donor (P = .032), with improved prognosis associated with longer perfusion time and shorter time in intensive care unit. Conclusions:The kidney donor has a direct effect on patient life expectancy and renal graft success after transplant.

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Section: Discussionmentioning

confidence: 97%

Untitled

Stolyar

Budkar²,

Solodushkin³

et al. 2015

Exp Clin Transplant

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“…Systolic hypertensive blood pressure (BP) as well as proteinuria are strong and independent predictive factors for graft survival in paediatric patients [47][48][49][50]. CIT represents an independent risk factor for delayed graft function [51,52]. As the Values are given as mean AE SD, median (min; max), or as absolute counts (percentage).…”

Section: Discussionmentioning

confidence: 99%

Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function?

et al. 2016

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SUMMARYChildren often merit priority in access to deceased donor kidneys by organ-sharing organizations. We report the impact of the new Swiss Organ Allocation System (SOAS) introduced in 2007, offering all kidney allografts from deceased donors <60 years preferentially to children. The retrospective cohort study included all paediatric transplant patients (<20 years of age) before (n = 19) and after (n = 32) the new SOAS (from 2001 to 2014). Estimated glomerular filtration rate (eGFR), urine protein-to-creatinine ratio (UPC), need for antihypertensive medication, waiting times to kidney transplantation (KTX), number of pre-emptive transplantations and rejections, and the proportion of living donor transplants were considered as outcome parameters. Patients after the new SOAS had significantly better eGFRs 2 years after KTX (Mean Difference, MD = 25.7 ml/min/ 1.73 m 2 , P = 0.025), lower UPC ratios (Median Difference, MeD = À14.5 g/mol, P = 0.004), decreased waiting times to KTX (MeD = À97 days, P = 0.021) and a higher proportion of pre-emptive transplantations (Odds Ratio = 9.4, 95% CI = 1.1-80.3, P = 0.018), while the need for antihypertensive medication, number of rejections and living donor transplantations remained stable. The new SOAS is associated with improved short-term clinical outcomes and more rapid access to KTX. Despite lacking longterm research, the study results should encourage other policy makers to adopt the SOAS approach.

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“…This finding was matched with some reports denoting that slow and delayed graft function are risk factors for T-cell and antibodymediated rejection 19 and the combination of both can affect patient survival. 20,21 Most of our patients were young females, and this was explained by Dörje and associates 2 who found that most of their patients with rejection were young and nonadherent with suboptimal immuno suppression.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Gheith

Al-Otaibi

Halim³

et al. 2017

Exp Clin Transplant

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Objectives: There are no comparable trials concerning the use of rituximab among renal transplant recipients with acute antibody-mediated rejection. Here, we compared early and late acute antibody-mediated rejection in renal transplant recipients in terms of response to rituximab therapy. Materials and Methods: Of 1230 kidney transplants performed at Hamed Al-Essa Organ Transplant Center (Kuwait) over the past 10 years, 103 recipients developed acute antibody-mediated rejections and were subcategorized into 4 groups according to the onset of rejection and rituximab treatment. All patients received the standard treatment for acute antibody-mediated rejection according to our protocol (plasma exchange and intravenous immunoglobulin). We added rituximab to the treatment regimen in 2 groups of patients: 27 patients with early rejection (group 1) and 38 patients with late rejection (group 2). Groups 3 and 4 represented nonrituximab groups, with 20 patients with early (group 3) and 18 patients with late rejection (group 4). We compared the 4 groups regarding graft and patient outcomes. Results: All patients were comparable regarding patient age, sex, pretransplant type of dialysis, viral profile, type of induction, donor criteria, and pretransplant comorbidities. We observed that delayed and slow graft function were significantly higher in groups 1 and 3 (P = .016); however, we found no significant differences in the 4 groups regarding new-onset diabetes after transplant, BK viral infection, and malignancy. Graft outcomes were significantly better in groups 1 and 2 than in groups 3 and 4 (P = .028). However, patient outcomes were comparable in the 4 groups (P > .05). Conclusions: Early acute antibody-mediated rejection in renal transplant recipients had significantly better outcomes when rituximab was added to the standard treatment regimen.

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The effect of cold ischemia time on delayed graft function and acute rejection in kidney transplantation

Cited by 25 publications

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Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function?

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