The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single‐center analysis

Zens, Tiffany; Danobeitia, Juan S.; Leverson, Glen; Chlebeck, Peter J.; Zitur, Laura J.; Redfield, Robert; D’Alessandro, Anthony M.; Odorico, Scott K.; Kaufman, Dixon B.; Fernández, Luis A.

doi:10.1111/ctr.13190

Cited by 106 publications

(96 citation statements)

References 22 publications

(37 reference statements)

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“…The likelihood of needing post‐operative hemodialysis was considered as a factor in the peri‐transplant management of the LL‐AVG. DGF was thought likely in 11 patients based on donor type and KDPI 9 . Of these 11, six patients went on to have DGF.…”

Section: Resultsmentioning

confidence: 99%

“…During this period, data were obtained for a consecutive cohort of 23 patients in whom a LL‐AVG was placed prior to receiving a renal transplantation. Data were obtained on previous renal replacement therapy history, indication for LL‐AVG, and complications; transplant details (details of organ accepted and received according to KDPI 9 ), transplant intraoperative details (side of organ insertion relative to LL‐AVG, cold ischemia time), kidney function post‐transplant and need for vascular access (immediate function, delayed graft function), post‐operative management of LL‐AVG (left alone, excised/ligated at time of transplant, and delayed ligation) were abstracted. No patients were lost to follow‐up.…”

Section: Methodsmentioning

confidence: 99%

“…These patients often have experienced significant time on hemodialysis, have a more complex vascular access history and comorbidity thus in order to facilitate timely transplantation higher KDPI donor organ offers may need to be considered. A higher KDPI reflects an increased donor age, comorbidity, or risk profile with a subsequently higher risk of delayed graft function 8‐10 . Thus, decisions about the management of the LL‐AVG in the pre‐transplant period can be difficult to balance as the risk of requiring hemodialysis post‐operatively must be weighed against the possibility that the maintenance of the LL‐AVG flow itself may be detrimental to the outcome of the transplant.…”

Section: Introductionmentioning

confidence: 99%

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The management of lower limb arteriovenous grafts in the perioperative period following renal transplantation

Isaak

Madurska

Stevenson

et al. 2020

Clinical Transplantation

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Background:The presence of a lower limb arteriovenous graft (LL-AVG) is indicative of a group of complex hemodialysis patients who have precarious long-term vascular access. The aim of this study is to describe our experience of the clinical decisions and interactions between LL-AVG and renal transplantation. Methods:The records of 23 patients who received a transplant in the presence of a LL-AVG between 2010 and 2018 were analyzed: firstly, to determine whether patients with a LL-AVG received extended criteria transplants, the implantation procedure, and the management of the LL-AVG in the post-operative period.Results: Seventeen patients (74%) had "end-stage access" and were thus considered for all offer stratified by the kidney donor profile index (KDPI) and donor type (DBD or DCD). In eleven patients (48%), a kidney with a high risk of delayed graft function was transplanted. Same-sided renal transplantation occurred in only 35% of cases, and of these, only one LL-AVG was ligated immediately to improve transplant perfusion. Conclusion:A patient-based approach applied in decision-making on management of the LL-AVG post-transplantation should include (a) the likelihood of delayed graft function, (b) the need for post-operative hemodialysis, (c) the side of proposed transplant compared to the LL-AVG, and (d) local complications. K E Y W O R D S clinical decision-making, delayed graft function, expanded criteria donor, lower limb arteriovenous grafts

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The management of lower limb arteriovenous grafts in the perioperative period following renal transplantation

Isaak

Madurska

Stevenson

et al. 2020

Clinical Transplantation

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“…Clinical information and laboratory results of potential donors are important for initial assessment of the quality of an organ. The Kidney Donor Profile Index (KDPI) is a score that estimates the risk of graft failure [21,22]. On the base of KDPI score combined with donors' actual situation in China, we consider donor age, cerebrovascular cause of death, history of hypertension, sCr before kidney procurement, hypotension and CPR incidence as a suitable donor evaluation system [15].…”

Section: Discussionmentioning

confidence: 99%

Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function

Zheng

Ding

et al. 2020

Renal Failure

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2020) Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function, Renal Failure, 42:1, 369-376, ABSTRACTBackground: Due to the current high demand for transplant tissue, an increasing proportion of kidney donors are considered extended criteria donors, which results in a higher incidence of delayed graft function (DGF) in organ recipients. Therefore, it is important to fully investigate the risk factors of DGF, and establish a prediction system to assess donor kidney quality before transplantation. Methods: A total of 333 donation after cardiac death kidney transplant recipients were included in this retrospective study. Both univariate and multivariate analyses were used to analyze the risk factors of DGF occurrence. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of variables on DGF posttransplant. Results: The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters (flow and resistance index) were all correlated. 46 recipients developed DGF postoperatively, with an incidence of 13.8% (46/333). Multivariate logistic regression analysis of the kidney transplants revealed that the independent risk factors of DGF occurrence post-transplantation included donor score (OR ¼ 1.12, 95% CI 1.06-1.19, p < 0.001), Remuzzi score (OR ¼ 1.21, 95% CI 1.02-1.43, p ¼ 0.029) and acute tubular injury (ATI) score (OR ¼ 4.72, 95% CI 2.32-9.60, p < 0.001). Prediction of DGF with ROC curve showed that the area under the curve was increased to 0.89 when all variables (donor score, Remuzzi score, ATI score and HMP resistance index) were considered together. Conclusions: Combination of donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.

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“…Following implementation of the new Kidney Allocation System (KAS) in the United States, rates of DGF increased from 24.3% to 29.5% of all kidney transplant procedures . The development of DGF has significant detrimental clinical and economic impacts for transplant recipients . Clinically, patients with DGF experience higher rates of acute rejection contributing to the development of donor‐specific antibodies and shortening long‐term graft survival .…”

Section: Introductionmentioning

confidence: 99%

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Axelrod

Malinoski

Patel

et al. 2019

Clinical Transplantation

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Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard donor management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low-cost intervention could reduce healthcare expenditures for providers and insurers. K E Y W O R D S cost, deceased organ donors, donor management, hypothermia 1 | INTRODUC TI ON The development of delayed graft function (DGF) after kidney transplantation has been increasing in recent years. Following implementation of the new Kidney Allocation System (KAS) in the United States, rates of DGF increased from 24.3% to 29.5% of all kidney transplant procedures. 1 The development of DGF has significant detrimental clinical and economic impacts for transplant 2 of 7 | AXELROD Et AL.recipients. 2-4 Clinically, patients with DGF experience higher rates of acute rejection contributing to the development of donor-specific antibodies and shortening long-term graft survival. 5-7 Economically, DGF results in longer length of stay, increased need for expensive lymphocyte depleting induction therapies, and an greater rate of return to dialysis. 3,8 A variety of modifiable and unmodifiable donor and transplant factors impact DGF rates. Donor demographic characteristics including creatinine, age, and recovery after cardiac death significantly increase the risk of DGF, as do recipient race (black), age, gender (male), and time on dialysis. It is also well established that increased cold ischemic time is associated with more DGF, which may explain the greater incidence of DGF after implementation of the KAS system. Strategies to prevent the development of DGF in the United States have generally been employed after organ recovery and have historically been expensive. Pulsatile perfusion of kidney allografts is associated with reduction in the incidence of DGF, especially in high-risk organs, but increases the initial cost of transplant. 3,9 Furthermore, a sizable number of kidney...

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The impact of kidney donor profile index on delayed graft function and transplant outcomes: A single‐center analysis

Cited by 106 publications

References 22 publications

The management of lower limb arteriovenous grafts in the perioperative period following renal transplantation

The management of lower limb arteriovenous grafts in the perioperative period following renal transplantation

Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

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