Risk Factors For Delayed Graft Function Research Articles

Effect of delayed graft function on immediate and long-term kidney transplant outcomes

Objective: to analyze the immediate and long-term outcomes of kidney transplantation (KT) depending on the duration of delayed graft function (DGF). Materials and methods. The study conducted a retrospective analysis of KT outcomes in 312 patients operated on at Botkin Hospital from June 2018 to December 2022. Exclusion criteria were primary non-function, severe surgical complications that required emergency transplantectomy in the first week after KT and cases where a comprehensive approach to DGF prevention was applied. DGF was defined as the need for dialysis within the first 7 days of KT. The severity of this complication was assessed by the time it took the transplanted kidney function to normalize from mild DGF to severe. We analyzed the immediate and long-term outcomes of KT depending on the presence of initial function and the severity of DGF. Results. DGF developed in 25.3% of cases. The mean time for graft function normalization was 16.5 ± 6.8 days. Mild DGF occurred in 68% of cases, severe DGF was determined in the remaining cases (32%). The incidence of complications was statistically significantly higher in the severe DGF group: 14/25 (56%) vs. 15/54 (27.8%) (p = 0.047). There were also no significant differences in the rate of complications between recipients with immediate and mild DGF: 43/233 (18.4%) vs. 15/54 (27.8%) (p > 0.05). Severe DGF lasting for more than 2 weeks had a statistically significant association with postoperative complications (p = 0.047) and with decreased long-term graft survival (log-rank p = 0.021). Conclusion. Development of severe DGF mainly depends on donor characteristics, timing and peculiarities of graft preservation. Nevertheless, other factors, such as acute calcineurin inhibitor nephrotoxicity, should not be ignored. Therefore, prevention of all potentially modifiable risk factors for DGF should go hand in hand with the expansion of the indications for donation.

Delayed graft function post renal transplantation: a review on animal models and therapeutics.

The incidence of end-stage renal disease (ESRD) has been increasing worldwide. Its treatment involves renal replacement therapy, either by dialyses or renal transplantation from a living or deceased donor. Although the initial mortality rates for patients on dialysis are comparable with kidney transplant recipients, the quality of life and long-term prognosis are greatly improved in transplanted patients. However, there is a large gap between availability and need for donor kidneys. This has led to the increase in the use of expanded kidney donor criteria. Allograft dysfunction immediately after transplant sets it up for many complications, such as acute rejection and shorter allograft survival. Delayed graft function (DGF) is one of the immediate posttransplant insults to the kidney allograft, which is increasing in prevalence due to efforts to maximize the available donor pool for kidneys and use of expanded kidney donor criteria. In this review, we discuss the risk factors for DGF, its implications for long-term allograft survival, animal models of DGF, and the therapeutic options currently under evaluation for prevention and management of DGF.

Delayed Graft Function in Kidney Retransplantation: United Network for Organ Sharing Data With Linked Primary and Retransplant

IntroductionThere are several articles exploring the risk factors for primary delayed graft function (DGF). However, current literature does not include many resources on the risk factors for DGF when it is a recipient's second kidney transplant or look at short-term graft and patient survival of DGF retransplants. MethodsUnited Network for Organ Sharing data from January 2008 to June 2021 were analyzed. Pancreas transplants, multi-organ transplants, and lost to follow-up transplants were excluded. Second transplant patients with DGF were identified. Multivariate logistic regression models based on the primary and second transplant characteristics were created. Survival analysis was performed with Kaplan-Meier methodology and assessed with log-rank test. ResultsA total of 2964 second kidney transplants were identified. Rate of DGF in the second transplant was 28.4% (843/2964) and 49.2% of them had a prior DGF in their first transplant (P < 0.001). Multivariate analysis confirmed that occurrence of DGF (odds ratio [OR] 1.5, P < 0.001) and graft loss due to acute rejection (OR 1.2, P < 0.005) in the primary transplant were predictors of reappearing DGF in the second transplant. Dialysis at transplant was the greatest risk factor from the second transplant (OR 3.539, P < 0.001). There was a decreased graft survival after 12 mo (77% versus 49% with log t-test <0.001) in the second transplant. However, DGF was not significantly associated with patient survival. ConclusionsThis study shows the interaction between primary and second transplant in developing DGF. Survival analysis shows lower graft survival for retransplants in the case of DGF. This study opens the possibility of identifying additional risk factors for patients undergoing retransplant surgeries.

Transoperative Hemodynamic Status and Delayed Graft Function: Analysis of 42 Consecutive Renal Transplantation

Objective: Evaluate the correlation between transoperative hemodynamic status and development of delayed graft function (DGF) in patients undergoing kidney transplantation. Methods: We analyzed 42 consecutive renal transplants between May 2021 and May 2022 in a University Hospital. Four kinds of variables were assessed. Recipients variables: age, gender, race, type of dialysis, dialysis time before transplantation and residual diuresis. Donor variables: age, serum creatinine level, death cause, race, laterality of the kidney (right or left kidney), perfusion solution and Kidney Donor Profile Index (KDPI). Surgical variables: cold Ischemia time (CIT), vascular multiplicity, the surgeon, duration of surgery and blood pressure during the procedure. Immunological variables: Panel reactive antibodies (PRA), HLA mismatches and the need of induction therapy with antithymocyte globulin. Results: In univariate analysis, regarding recipients’ factors, type of dialysis (hemodyalisis) (p=0.004) and absence of residual diuresis (p=0.011) were significant on the development of DGF. Among the donors, only the laterality of the kidney (right kidney) was statiscally significant (p=0.005). The cold ischemia time higher than 24 hours (p=0.022), systolic blood pressure (SBP) less than 130 mmHg at reperfusion (p&lt;0.001), Mean Arterial Pressure (MAP) less than 80 mmHg at the reperfusion (p&lt;0.001), and mean MAP post-reperfusion (p=0.049) were the significant surgical factors for DGF. Among immunological factors, the patients that received antithymocyte globulin as induction therapy more frequently developed DGF (p=0.036). Only MAP &lt; 80 mmHg (p=0.004) and SBP &lt; 130m mmHg (p=0.005) were independent risk factors for DGF. Conclusion: In this survey, optimal renal perfusion, avoiding fall in blood pressure in the transoperative period, especially after graft reperfusion, is crucial for the immediate functioning of the kidney

Intraoperative Hemodynamic Parameters Associated With Delayed Graft Function in Kidney Transplant Patients

Intraoperative hemodynamic instability was proven to be associated with delayed graft function (DGF) after kidney transplantation. This retrospective study aims to find the specific intraoperative hemodynamic parameters as an efficient predicting factor of DGF. Patients who underwent kidney transplantation between 2020 and 2022 were enrolled and classified into DGF and non-DGF groups. Pediatric and multiorgan recipients were excluded. Hemodynamic parameters such as central venous pressure, mean arterial pressure, cardiac output, and cardiac index (CI) at the timings of wound incision, graft reperfusion, and operation completion were recorded, respectively. A comparison of parameters between these 2 groups was analyzed. We enrolled 42 recipients, with 26 in the DGF group and 16 in the non-DGF group. Compared with the DGF group, CI around graft reperfusion was significantly higher in the non-DGF group (3.97 vs 4.67 L/min/m2, P=.043). Other hemodynamic variables revealed no statistical difference. In the results of multivariate analysis, the deceased donor source, the greater volume of blood loss, and the lower CI around graft reperfusion were considered independent risk factors for DGF. Using CI around graft reperfusion to conduct a receiver operating characteristic (ROC) curve for DGF prediction, the area under the ROC curve achieved a value of 0.739 (95% confidence interval, 0.579-0.900), with the optimal cut-point value at CI=4.245 L/min/m2. The cardiac index value around graft reperfusion was statistically associated with the incidence of DGF and might be used as a valid predicting factor.

A Multiparametric Nomogram for Predicting Delayed Graft Function in Adult Recipients of Pediatric Donor Kidneys

Delayed graft function (DGF) is one of the most common postoperative complications after kidney transplantation. The ability to predict DGF after transplantation can greatly aid clinical decision-making. Several models have been proposed to predict DGF in adult recipients of adult donor kidneys, but there is currently no model to predict DGF in adult recipients of pediatric donor transplants. Therefore, based on our medical records, we retrospectively investigated the pretransplant risk factors of DGF in transplants from pediatric donors to adult recipients. Our center is in compliance with national laws, the Declaration of Istanbul, and the Helsinki Congress. The donors used by us were organs donated after the death of citizens and the participants were neither paid nor coerced. A retrospective review of 84 adult patients who received pediatric donor kidneys at a single center from April 4, 2015 to November 17, 2021 was conducted to investigate the pretransplant risk factors for the development of DGF. DGF was observed in 45 of 68 patients (66.17%) in the training group and 9 of 16 patients (56.25%) in the validation group. Multivariate logistic analysis showed that kidney donor profile index, cold ischemia time, number of human leukocyte antigen mismatches, and pretransplant dialysis duration were significant independent risk factors for DGF. By integrating these 4 factors, we constructed a nomogram model to predict DGF. According to the prediction model, the area under the curve of DGF of the training group and validation group was 0.899 and 0.905, respectively. We have constructed a novel, reliable, and accurate visual nomogram that provides a practical tool for predicting DGF in adult recipients of pediatric donor kidneys.

Analysis of Risk Factors for Delayed Graft Function After Kidney Transplantation

Delayed graft function (DGF) is a serious complication associated with worsening outcomes in kidney transplantation. To facilitate DGF risk reduction, this study aimed to identify the incidence and modifiable risk factors of this condition in kidney transplant patients. This retrospective chart review included 220 patients who underwent kidney transplants between 2012 and 2021 at our kidney transplant center. Delayed graft function was defined as the requirement of hemodialysis within a week of transplantation. Clinical data from patients with DGF and those without this condition were compared to identify risk factors of DGF. Of 205 eligible patients, 20 (9.76%) developed DGF. In the univariate analysis, high hemoglobin level, deceased-donor type, and longer warm and cold ischemic times were significantly associated with DGF (P < .05). In the variable selection in logistic regression analysis, high hemoglobin level, with a cutoff value of 11.35 g/dL, and deceased-donor transplants were associated with higher DGF incidence (P < .05 for both factors). Our findings newly demonstrated that DGF occurred more frequently in patients with hemoglobin level >11.35 g/dL. As such, improvement in kidney transplantation outcomes could be achieved by reducing this modifiable risk factor.

Anesthetic Challenges and Perioperative Factors Affecting Delayed Graft Function in Robotic-Assisted Kidney Transplant: A Review of a Single-Center Experience of 100 Cases.

Background and objectiveThe advent of robot-assisted kidney transplant (RAKT) has ushered in a new set of challenges. In this single-center retrospective observational study, we aimed to highlight the anesthetic challenges and analyze perioperative parameters to identify the risk factors for delayed graft function (DGF) in RAKT.MethodsA descriptive analysis of perioperative factors of the first 100 cases of RAKT at our center was performed. Data were retrieved from the hospital's electronic medical records (EMR) of donors and adult patients who underwent RAKT between July 2015 and December 2020. The data analyzed included demographics, preoperative optimization, intraoperative and postoperative management, and complications. DGF was defined as a requirement of dialysis within one week of transplant. The Fisher’s exact test, independent sample t-test, and the Mann-Whitney test were used to analyze data.ResultsAmong a total of 193 renal transplants performed during the study period, 100 patients underwent RAKT, which included 27 females and 73 males. Of these, 91 were live while the remaining involved deceased-donor transplants. Pneumoperitoneum and steep Trendelenburg position required various “anesthetic maneuvers” to maintain hemodynamics and respiratory parameters. Optimal fluid management, with frusemide and mannitol, ensured good urine output (UOP) (93%). Post-reperfusion, the release of pneumoperitoneum, maintenance of adequate perfusion pressures, immunosuppression, and regional hypothermia helped in ensuring adequate graft function (93%). The incidence of DGF in our series was 7% and the mortality rate was 3%. Recipient age (p=0.045), dyslipidemia (p=0.021), and diabetes mellitus (p=0.023) were identified as significant risk factors for DGF.ConclusionAdvanced recipient age, diabetes, and dyslipidemia were factors significantly associated with DGF in RAKT in our series of 100 cases. However, the duration of the steep Trendelenburg position, docking of robot/pneumoperitoneum (console time), fluid management, warm and cold ischemia times, rewarming time, and type of graft did not influence DGF. Awareness of the systemic involvement in RAKT, proper preoperative optimization, and knowledge of potential problems are essential for the efficient anesthetic management of RAKT.

316.1: Incidence and Effect on Survival of Delayed Graft Function in Donor-Deceased Kidney Transplants in Argentina: A Multicenter Analysis

Introduction: Delayed graft function (DGF) is a manifestation of acute kidney injury with attributes unique to the transplant process. DGF is associated with negative outcomes such as higher incidence of acute rejection, worse graft function and lower grafts and patients´ survival. Although the worldwide incidence of DGF is variable, a previous study showed that the incidence in Argentina is higher than the US and most countries in Europe. Therefore, the aim of our study was to identify the risk factors associated with DGF in Argentina and to evaluate the impact of DGF on grafts´ and patients´ survival. Methods: Retrospective multicenter cohort study of deceased-donor kidney transplant from 33 transplant centers in Argentina between 2015 and 2017. Demographic data and donor and recipient related variables were analyzed at baseline and at 3 and 5 years of follow-up. Data were obtained from SINTRA/ INCUCAI, the Argentinian procurement organization and from the transplant centers. Results: Between 2015 and 2017, 1886 single kidney transplants were performed in 33 centers. Recipient and donor characteristics are shown in Table 1. In the current study, the incidence of DGF was 62%. Univariate analysis demonstrated that higher donor creatinine, donor age, recipient time on dialysis, donor BMI, absence of induction and cold ischemia time were risk factors associated with DGF. Multiple organ donation and cause of death other than stroke were associated with reduced risk DGF. In the multivariable analysis donor age (0.02), higher donor creatinine (0.02), recipient time on dialysis (<0.01), cold ischemia time (<0.01), monorganic donor (<0.01)) were risk factors of DGF. Renal function was significatively better in patients without DGF throughout the 5 years follow -up (p<0.05). Patients with DGF had higher incidence of acute rejection in the first three months of follow-up, with T-cell mediated rejection being the most frequent. At 3 and 5 years of follow up there was no increased risk of rejection when both groups were compared. Graft survival and patient survival were lower in the group that developed DGF at 1, 3 and 5 years of follow-up (<0.01) (Figure 1). Conclusion: We confirmed the high incidence of DGF in our country. Furthermore, the analysis on the risk factors associated with DGF were not as much as different as in other countries where the incidence of DGF were lower. Further studies should be done to unravel the cause of this high incidence of DGF in Argentina. Heads of Transplant Centers: WalterJ, Raffaele P, Ciappa M, Paladini J, De la Fuente J, Novoa P, Soler Pujol G, Toselli L, Suso E, Ferreyra M, Fragale G, Reinoso S, Acosta F, Sgrosso J, Arriola M, Maldonado R, Acosta M, Prado R, Sedevich A, Martinez I, Di Pietrantonio S, Oddino J, Trimarchi H, Raimondi C, Gómez M, Dorado E, Palti G, Mele P, Maggiora E, Papaginovic Leiva M. Kidney Commitee: Ibañez J, Benitez ML, Leon L, Mesias M, Osella F.

243.2: Pediatric Kidney Transplantation in Argentina: Is Delayed Graft Function a Problem? Results of a Multicenter Study

Introduction: Delayed graft function (DGF) is a manifestation of acute kidney injury occurring after kidney transplantation (KTx). Incidence of DGF in pediatric KTx recipients is variable (10% to 25%) due to different definitions of DGF and different subgroups of kidney donors. It is associated with an increased risk of graft loss in adult KTx. Several factors related to donor, recipient, and organ procurement/transplantation procedures may increase the risk of DGF. The aim of our study was to evaluate the cumulative incidence of DGF in a children who received a kidney graft from a brain-dead donor, its impact on patient and graft survival, and to identify predictive risk factors of DGF. Methods: A retrospective multicenter study was conducted including recipients under 18 years of age who underwent KTx from a brain-dead donor between January 1, 2015 and December 31, 2017. DGF was defined as the need for dialysis within the first week after KTx. Data were obtained from the clinical records of the patients and from the Registry and Management System of Argentina (SINTRA) and were analyzed using MedCalc® Statistical Software version 20.014; 2021. Results: We analyzed 239 KTx performed at 17 centers. Of the recipients 54.4% were male, median age at Tx was 13.7 yr (r: 2.8 -17.9), weight 30 kg (r: 7 - 82), BMI 17 Kg/m2 (r: 11 - 36). Etiology of ESRD: CAKUT 30%, glomerular diseases with risk of recurrence 24.3%, typical HUS 3.8%, others 29.7%, and unknown 12.2%. Pre-emptive KTx was performed in 18.8% of patients, 39.7% were receiving hemodialysis, and 41.5% peritoneal dialysis. Median of time on dialysis was 2.62 yr (r: 0.12 - 9.8). Of the donors 70.7% were male, median age was 17.6 yr (r: 2.8 - 55), BMI 23 Kg/m2 (r: 17 - 35), BMI ratio donor/recipient 1.35, and pre-ablation serum creatinine 0.82 mg/dl (r: 0.6 - 2.6). Cause of death was trauma in 57%, vascular in 24%, and others in 19%. Cold ischemia time was 16.6 hours (r: 4.2 - 42), HLA mismatches ≼ 3: 54% and > 3: 46 %. Multiple-organ donor in 84.5%. Overall, 59 patients (24.7%) developed DGF. Patients without DGF had better graft survival at 1 (96% vs 78%) and 3 yrs of follow-up (89% vs 73%) p= 0.001. There were no significant differences in patient survival between both groups at the 3-year follow-up (95% vs 91%). Incidence of early AR (90 days post Tx) was higher in patients with DGF (34.5% vs 10.6%) p= 0.0001. In univariate analysis risk factors for DGF were: age at Tx > 13.7 yr, male gender, glomerular disease with risk of recurrence, hemodialysis as prior to KTx, and time on dialysis > 1 yr. In multivariate analysis independent risk factors for DGF were: time on dialysis > 1 yr (OR 9.2 - 95% CI 2.1 - 39) and age at KTx > 13.7 yr (OR 1.09 - 95% CI 1.01 - 1.18). Conclusion: In our cohort, cumulative incidence of DGF was higher than that reported by other authors. Patients with DGF had worse graft survival than those without DGF. Shortening the time on dialysis seems to be a modifiable factor to reduce DGF.

Contrast-Enhanced Ultrasonography Value for Early Prediction of Delayed Graft Function in Renal Transplantation Patients.

Delayed graft function (DGF) is a common early complication after kidney transplantation. The aim of the present study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in the early prediction of DGF after kidney transplantation. A total of 89 renal transplant recipients were retrospectively enrolled and divided into DGF group or normal graft function (NGF) group according to the allograft function. Conventional Doppler ultrasound and CEUS examination data on the first postoperative day were collected and analyzed. The resistive indices of segmental and interlobar artery in the DGF group were significantly higher than those in the NGF group (0.71 ± 0.17 versus 0.63 ± 0.08, P=.006; 0.70 ± 0.16 versus 0.62 ± 0.08, P=.004, respectively). The patients experiencing DGF had significantly lower PI-c (14.7dB ± 6.1dB versus 18.5 dB ± 3.3dB, P=.001) and smaller AUC-c (779.8 ± 375.8dB·seconds versus 991.0 ± 211.7dB·seconds, P=.003), as well as significantly lower PI-m (12.6dB ± 5.9dB versus 15.9 dB ± 3.9dB, P=.006), shorter MTT-m (30.7 ± 9.4seconds versus 36.3 ± 7.1seconds, P=.01), and smaller AUC-m (P=.007). Multivariate analysis demonstrated that PI-c, AUC-c, and MTT-m were independent risk factors for DGF. The area under the receiver operating characteristic curve values of the combined predicted value (PI-c + MTT-m, PI-c + AUC-c + MTT-m) of DGF incidence were bigger than that of PI-c, AUC-c, or MTT-m. CEUS parameters of the cortex and medulla have a good value for an early prediction of DGF after renal transplantation.

Effect of Ischemia Times and Donor and Recipient Features on Maastricht Category III Kidney Transplant Outcomes.

Expansion of the donor pool has been enabled by the use of donation after circulatory death (DCD). The aim of this study is to identify what donation features are able to predict kidney transplant (KT) outcomes from DCD. A prospective analysis of all DCD KT from June 2016 to November 2019 was conducted. Association between donor and recipient features, and ischemia times with delayed graft function (DGF) and serum creatinine (Cr) at discharge, and at three and twelve months were analysed. A total of 86 KT were performed. The results revealed a relationship between donor age (p = 0.014) and receptors on haemodialysis (p = 0.001) with DGF. There was no association between different ischemia times and DGF. Residual urine output greater than 500mL/day and being on peritoneal dialysis were found to be protective factors for DGF. Correlation analysis illustrated a significant correlation between donor age and Cr at discharge and at 3 months. Higher donor age and being on haemodialysis were risk factors for DGF. Likewise, donor age did not show a significant association with 12-month serum Cr. These results demonstrate that donor age is a risk factor for DGF but does not affect long term graft function.

Pretransplant Serum Uromodulin and Its Association with Delayed Graft Function Following Kidney Transplantation-A Prospective Cohort Study.

Delayed graft function (DGF) following kidney transplantation is associated with increased risk of graft failure, but biomarkers to predict DGF are scarce. We evaluated serum uromodulin (sUMOD), a potential marker for tubular integrity with immunomodulatory capacities, in kidney transplant recipients and its association with DGF. We included 239 kidney transplant recipients and measured sUMOD pretransplant and on postoperative Day 1 (POD1) as independent variables. The primary outcome was DGF, defined as need for dialysis within one week after transplantation. In total, 64 patients (27%) experienced DGF. In multivariable logistic regression analysis adjusting for recipient, donor and transplant associated risk factors each 10 ng/mL higher pretransplant sUMOD was associated with 47% lower odds for DGF (odds ratio (OR) 0.53, 95% confidence interval (95%-CI) 0.30–0.82). When categorizing pretransplant sUMOD into quartiles, the quartile with the lowest values had 4.4-fold higher odds for DGF compared to the highest quartile (OR 4.41, 95%-CI 1.54–13.93). Adding pretransplant sUMOD to a model containing established risk factors for DGF in multivariable receiver-operating-characteristics (ROC) curve analysis, the area-under-the-curve improved from 0.786 [95%-CI 0.723–0.848] to 0.813 [95%-CI 0.755–0.871, p = 0.05]. SUMOD on POD1 was not associated with DGF. In conclusion, higher pretransplant sUMOD was independently associated with lower odds for DGF, potentially serving as a non-invasive marker to stratify patients according to their risk for developing DGF early in the setting of kidney transplantation.

A prediction model of delayed graft function in deceased donor for renal transplant: a multi-center study from China

Background Kidneys obtained from deceased donors increase the incidence of delayed graft function (DGF) after renal transplantation. Here we investigated the influence of the risk factors of donors with DGF, and developed a donor risk scoring system for DGF prediction. Methods This retrospective study was conducted in 1807 deceased kidney donors and 3599 recipients who received donor kidneys via transplants in 29 centers in China. We quantified DGF associations with donor clinical characteristics. A donor risk scoring system was developed and validated using an independent sample set. Results The incidence of DGF from donors was 19.0%. Six of the donor characteristics analyzed, i.e., age, cause of death, history of hypertension, terminal serum creatinine, persistence of hypotension, and cardiopulmonary resuscitation (CPR) time were risk factors for DGF. A 49-point scoring system of donor risk was established for DGF prediction and exhibited a superior degree of discrimination. External validation of DGF prediction revealed area under the receiver-operating characteristic (AUC) curves of 0.7552. Conclusions Our study determined the deceased donor risk factors related to DGF after renal transplantation pertinent to the Chinese cohort. The scoring system developed here had superior diagnostic significance and consistency and can be used by clinicians to make evidence-based decisions on the quality of kidneys from deceased donors and guide renal transplantation therapy.

HIV-positive deceased donor-to-HIV-positive recipient kidney transplantation: The HOPE must go on.

Nowadays, HIV infection is a chronic disease, this is due to the efficacy of antiretroviral therapy (ART) in the control of viral replication. The prevalence of chronic kidney disease (CKD) among those well-controlled HIV positive (HIV+) patients is higher than in the general population and kidney transplantation has been established as the best therapeutic option for HIV+ patients with end-stage renal disease. However, this population has lower access to transplantation.

A PREDICTION MODEL OF DELAY GRAFT FUNCTION FROM DECEASED DONOR RISK FACTOR: A MULTI-CENTER STUDY FROM CHINA

Background: The quality of deceased donation seriously increased the incidence of delayed graft function (DGF) after renal transplantation. However, there is still no recognized donor evaluation system for DGF prediction in China. This study investigated the impact of donor risk factor on DGF and developed a donor risk score system for DGF prediction. Methods: A total of 1807 deceased donors and 3599 their donated renal transplant performed in 22 center of China were included this retrospective study. Associations of DGF with the clinical characteristics of donors were quantified by univariate analysis. A donor risk scoring system was developed by multivariate logistic regression and validated using an independent sample. Results: In this retrospective multi-center study, the incidence of DGF was 18.7% from donor aspect. Six donor characteristics and different layings including age, primary disease, hypertension history, terminal serum creatininer, and hypotension persistent and CPR tine were risk factors of DGF. A 49-point score system of donor risk was established for DGF prediction which showed a good degree of discrimination. The prediction model was achieved an area under the curve of 0.7423 (95% CI 0.69-0.79) in predicting DGF in internal validation. The AUROC was 0.7552 (95% CI0.67-0.84) in external validation by a independent one center sample compared to Irish model which demonstrated an AUROC of 0.6181 (95% CI 0.53-0.70). Conclusion: The study determined deceased donor risk factors related to DGF after renal transplantation in China and firstly develop a scoring system in line with the characteristics of the Chinese population for DGF prediction more effectively. The scoring system had good diagnostic significance and consistency and can be used by clinicians to make evidence-based decisions on the use of renal from deceased donor and guiding renal transplantation therapy.

Outcomes of kidney transplantation from elderly deceased donors of a Korean registry

To overcome organ shortage, expanded criteria donors, including elderly deceased donors (DDs), should be considered. We analyzed outcomes of kidney transplantation (KT) from elderly DDs in a nationwide study. In total, data of 1049 KTs from DDs using the database of Korean Organ Transplantation Registry (KOTRY) were retrospectively analyzed based on the age of DDs: age ≥60 years vs. <60 years. Clinical information, graft status, and adverse events were reviewed in DDs and recipients. The mean age of the 1006 DDs was 51.04±10.54 years, and 21.5% of donors were aged ≥60 years. Elderly DDs had a significantly higher prevalence of diabetes and hypertension and higher Kidney Donor Risk Index (KDRI) and Kidney Donor Profile Index (KDPI). The mean age of the recipients was 47.45±14.87 years. Patients who received KT from elderly DDs were significantly older (53.12±15.14 vs. 45.88±14.41, P<0.001) and had a higher rate of diabetes (41.9 vs. 24.4%, P<0.001). Graft outcomes were not significantly different. Renal function was similar between the groups at the time of discharge and at 6 months, 1 year, and 2 years after KT. The rate of delayed graft function (DGF) was not significantly different. Risk factors of DGF were significantly different in DDs aged ≥60 years and <60 years. In the multivariable model, male sex (odds ratio: 3.99, 95% confidence interval: 1.42–11.22; P = 0.009) and KDRI (12.17, 2.23–66.34; P = 0.004) were significant risk factors for DGF in DDs aged ≥60 years. In DDs aged <60 years, thymoglobulin induction (2.62, 1.53–4.48; P<0.001) and continuous renal replacement therapy (3.47, 1.52–7.96; P = 0.003) were significant factors. Our data indicated that graft outcomes, including renal function and DGF, were similar for elderly DDs and DDs aged <60 years. Elderly DDs might be considered tolerable donors for KT, with active preoperative surveillance.

Impact of Cold Ischemia Time on Kidney Transplant: A Mate Kidney Analysis

IntroductionLonger cold ischemia time (CIT) is a deleterious factor for kidney transplant (KTx) outcomes and may lead Tx teams to graft discard. Because the CIT in Brazil is overall very high, the objective of this study was to compare outcomes among mate recipients of KTx with distinct CIT. MethodsWe studied 106 mate recipients of KTx in a single center followed for 1-year post-Tx. Mate kidneys were analyzed comparing the first and the second recipient to be transplanted. In a second analysis, we grouped mate recipients according to the CIT: ≤ 20 hours, > 20 hours, and mixed CIT. ResultsSeventy percent were standard criteria donors, with a mean Kidney Donor Profile Index (KDPI) of 61.5 ± 28%. KTx recipients presented an overall delayed graft function (DGF) rate of 82%, lasting 12 ± 7 days. The analysis of pairs considering the first and second recipient to be transplanted resulted in a longer CIT for the second (23.6 h vs 27 h; P = .001), and we did not find differences of outcomes after 1-year follow-up. Comparing pairs according to CIT (> 20h and ≤ 20h), DGF was higher in the CIT group > 20 hours (87.5% vs 58%; P = .002), with no differences of outcomes in 1-year follow-up. The logistic regression analysis shows that CIT > 20 hours is a risk factor for DGF in our study. ConclusionCIT > 20 hours is a risk factor for DGF, therefore strategies to reduce the CIT are always necessary.

Delayed Graft Function in Simultaneous Liver Kidney Transplantation.

Delayed graft function (DGF) is associated with inferior posttransplant outcomes in kidney transplantation. Given these adverse outcomes, we sought to determine the incidence, unique risk factors, and posttransplant outcomes for simultaneous liver kidney (SLK) transplant recipients developing DGF. We studied 6214 adult SLK recipients from March 2002 to February 2017 using the Scientific Registry of Transplant Recipients. We determined associations between risk factors and DGF using Poisson multivariate regression and between DGF and graft failure and mortality using Cox proportional hazard analysis. The overall rate of DGF was 21.8%. Risk factors for DGF in the hepatitis C virus (HCV)-negative recipient population included pretransplant dialysis (adjusted incident rate ratio [aIRR] 3.26, P = 0.004), donor body mass index (aIRR 1.25 per 5 kg/m, P = 0.01), and transplantation with a donation after circulatory death (aIRR 5.38, P = 0.001) or imported donor organ (regional share aIRR 1.69, P = 0.03; national share aIRR 4.82, P < 0.001). DGF was associated with a 2.6-fold increase in kidney graft failure (adjusted hazard ratio [aHR] 2.63, P < 0.001), 1.6-fold increase in liver graft failure (aHR 1.62, P < 0.001), and 1.6-fold increase in mortality (aHR 1.62, P < 0.001). In HCV-negative SLK recipients, recipient pretransplant dialysis and components of kidney graft quality comprise significant risk factors for DGF. Regardless of HCV status, DGF is associated with inferior posttransplant outcomes. Understanding these risk factors during clinical decision-making may improve prevention of DGF and may represent an opportunity to improve posttransplant outcomes.

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis.

This study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. A total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. Most patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, ≥ 1 or high dose vasopressors and blood glucose. Some DMR variables were associated with DGF, suggesting a potential impact of variables reflecting poor clinical and hemodynamic status on the incidence of DGF.