Slow Graft Function Research Articles

Intraoperative central venous pressures related to early graft function in deceased donor kidney transplant recipients with low immunological risks

This study aims to analyze data from patients who received kidney transplantation from deceased donors to investigate the anesthetic factors influencing early and late graft outcomes, including the incidence of slow graft function (SGF), delayed graft function (DGF), and 3-year graft outcomes. We retrospectively analyzed 202 recipients who underwent deceased donor kidney transplantation from March 2010 to December 2020. Anesthetic monitoring data during the intraoperative period was analyzed at 5-minute intervals, and basic clinical parameters were evaluated. The mean recipient age was 46.6 ± 10.3 years, and the mean donor age was 41.7 ± 12.7 years. Anesthetic time averaged 285.8 ± 70.2 min, and operation time averaged 223.1 ± 44.0 min. The incidence of SGF was 11.8%, and the incidence of DGF was 3.9%. Mean central venous pressures (CVPs) were higher in recipients with SGF or DGF (11.7 mmHg) compared to those with immediate graft function (9.7 mmHg). Higher CVP was identified as an independent risk factor for SGF or DGF (odds ratio 1.219, p = 0.006). This study suggests that intraoperative monitoring of CVP is crucial for predicting short-term graft function in deceased donor kidney transplantation and should be managed to prevent excessive fluid intake.

Can Post-transplant Congestive Nephropathy from Hypervolemia Cause Slow Graft Function?

Can Post-transplant Congestive Nephropathy from Hypervolemia Cause Slow Graft Function?

The differential impact of early graft dysfunction in kidney donation after brain death and after circulatory death: Insights from the Dutch National Transplant Registry

Kidneys donated after circulatory death (DCD) perform similarly to kidneys donated after brain death (DBD). However, the respective incidences of delayed graft function (DGF) differ. This questions the donor type-specific impact of early graft function on long-term outcomes. Using competing risk and Cox-regression analysis, we compared death-censored graft loss between types of early graft function: DGF (temporary dialysis dependency started within 7 days after transplantation), slow graft function (3-day plasma creatinine decline less than 10% per day), and immediate graft function. In 1061 DBD and 1605 DCD graft recipients (January 2014 until January 2023), graft survival was similar. DGF was associated with death-censored graft loss in DBD and DCD (adjusted hazard ratios: DGF in DBD: 1.79 [1.04-2.91], P = .027, DGF in DCD: 1.84 [1.18-2.87], P = .008; Reference: no DGF). Slow graft function was associated with death-censored graft loss in DBD, but not significantly in DCD (adjusted hazard ratios DBD: 2.82 (1.34-5.93), P = .007, and DCD: 1.54 (0.72-3.35), P = .262; Reference: immediate graft function). Early graft dysfunction has a differential impact on graft outcome in DBD and DCD. The differences between DBD and DCD should be accounted for in research and the clinic.

P.230: Outcome of delayed graft function and slow graft function in renal transplant recipients in a tertiary care Centre in eastern India.

P.230: Outcome of delayed graft function and slow graft function in renal transplant recipients in a tertiary care Centre in eastern India.

341.11: Prognostic factors in living donor kidney transplantation (LDKT): Preliminary data for the use of slow graft function (SGF) as a decision-making tool.

341.11: Prognostic factors in living donor kidney transplantation (LDKT): Preliminary data for the use of slow graft function (SGF) as a decision-making tool.

Prevalence and factors leading to delayed graft function and slow graft function in living donor kidney transplantation at tertiary care hospital, Karachi.

Introduction: The level of function of a transplanted kidney in the immediate postoperative period is correlated with long-term graft. Delayed graft function (DGF) is associated with acute rejection, prolonged hospital stays, and healthcare costs, as well as increased rates of graft failure. Objectives of study was to determine the frequency of DGF and Slow graft function (SGF) among living donor kidney transplants. Secondly, to compare frequency of factors responsible for slow and delayed graft function. Subjects and methods: Descriptive study done at Department of Transplantation, from 22nd October 2019 to 23rd April 2020. All patients undergoing first living donor renal transplants of both genders with recipient age 18-50 years and had ESRD due to all causes were included. The data related to donor factors, recipient factors, and transplant factor were noted. The frequency of SGF and DGF was noted after early post-transplant period. The leading factors evaluated for the SGF & DGF were compared with IGF. Results: The mean age of the donors was 32.15 ±8.68 years. Only 9 (5.7%) donors had >50 years age whereas female gender was reported as 65 (41.1%). BMI >30kg/m2 was found in only 2 (1.3%) recipients. The mean warm ischemia time was 1.01 ±1.36. None of the patient had WIT of >30. IGF was found in 154 (97.50%) patients, SGF in 3 (1.9%) and DGF in 1 (0.6%) patient. Conclusion: The frequency of DGF was found to be 0.6% and SGF 1.6% among living donor kidney transplants.

Role of Serum and Urine Neutrophil Gelatinase-associated Lipocalin as Biomarkers for Assessing Graft Function in Kidney Transplant Recipients.

The existing biomarkers used to promptly identify graft dysfunction after kidney transplantation lack consistency. Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker but its levels measured from serum and urine have demonstrated varying predictive values. Our study aimed to explore the potential of NGAL as a biomarker in predicting graft dysfunction in kidney transplant patients, including live and deceased donor recipients. A single-centered observational cohort study with live and deceased kidney recipients as participants was conducted between 2018 and 2022 at a tertiary care hospital in Southern India. Serum creatinine levels were monitored daily; creatinine reduction on day two and day seven were calculated. The recipients were categorized based on graft recovery into three groups: delayed graft function (DGF), slow graft function (SGF), or immediate graft function (IGF). Analysis of serum and urine NGAL was conducted two hours after the transplant and their predictive values were evaluated by the area under the curves (AUC) method. Of the 40 participants, 34 (85.0%) received their transplant from live-related donors, while six (15.0%) received kidneys from deceased donors. DGF occurred in four (10.0%) patients, SGF in 12 (30.0%), and 24 (60.0%) patients achieved IGF. Serum NGAL demonstrated higher sensitivity compared to urine NGAL. At a cut-off value of 678 ng/mL (AUC = 0.77), serum NGAL showed 90.0% sensitivity and 53.0% specificity. Urine NGAL had 70.0% sensitivity and 74.0% specificity at a cut-off value of 489 ng/mL (AUC = 0.72). Kidney recipients in SGF and DGF categories had elevated levels of serum and urine NGAL compared to those without IGF. Although serum NGAL showed higher sensitivity than urine NGAL in predicting graft dysfunction, both markers lacked the specificity needed for accurate predictions.

Urinary Biomarkers for Cell Cycle Arrest TIMP-2 and IGFBP7 for Prediction of Graft Function Recovery after Kidney Transplantation.

TIMP-2 and IGFBP7 have been identified and validated for the early detection of renal injury in critically ill patients, but data on recovery of allograft function after kidney transplantation (KTx) are scarce. In a prospective observational multicenter cohort study of renal transplant recipients, urinary [TIMP-2] × [IGFBP7] was evaluated daily from day 1 to 7 after KTx. Different stages of early graft function were defined: immediate graft function (IGF) (decrease ≥ 10% in serum creatinine (s-crea) within 24 h post KTx); slow graft function (SGF) (decrease in s-crea < 10% within 24 h post KTx); and delayed graft function (DGF) (any dialysis needed within the first week after KTx). A total of 186 patients were analyzed. [TIMP-2] × [IGFBP7] was significantly elevated as early as day 1 in patients with DGF compared to SGF and IGF. ROC analysis of [TIMP-2] × [IGFBP7] at day 1 post-transplant for event "Non-DGF" revealed a cut-off value of 0.9 (ng/mL)2/1000 with a sensitivity of 87% and a specificity of 71%. The positive predictive value for non-DGF was 93%. [TIMP-2] × [IGFBP7] measured at day 1 after KTx can predict early recovery of transplant function and is therefore a valuable biomarker for clinical decision making.

Multiple Renal Arteries in Live Donor Renal Transplantation and Impact on Graft Function and Outcome: A Retrospective Study

Objective: The objective of the study is to evaluate the outcomes of live-donor renal allografts with multiple and single renal arteries taking into consideration ischemia times, graft function, and other complications including vascular and urological. Materials and Methods: We conducted a retrospective study by analyzing a prospectively maintained database from January 2021 to December 2021 of all patients undergoing live-related renal allograft transplants at a tertiary care center in North India. A total of 239 live donor kidney transplants were performed during this period. Patients were divided into two groups – Group 1: Single artery single anastomosis and Group 2: Multiple arteries with two or more anastomoses. Duplex imaging of the graft was done at 6 months. Recipients were followed up for possible graft dysfunction, arterial insufficiency, and major urological complications. Results: Mean ischemia times in the two groups were 20.62 ± 1.05 and 30.45 ± 1.77 min, respectively. Failure to normalize creatinine (&lt;1.2 mg/dl) within 72 h was seen in 6/183 and 3/56 (P &gt; 0.05). Slow graft function was encountered in 6 cases in Group 1 and 3 cases in Group 2. Delayed graft function occurred in two patients in both groups. One-year graft survival among the groups was 5/183 and 2/56, respectively (P &gt; 0.05). One patient from Group 1 developed transplant renal artery stenosis. Six patients from Group 1 developed ureteric complications. Conclusion: Donor grafts with multiple renal arteries may be accepted safely with careful surgical reconstruction and close surveillance posttransplant.

Significance of nuclear medicine methods for diagnosis and predicting the course of renal transplantation complications

Renal transplantation is a replacement-based therapeutic method in end-stage kidney failure.It is based on the interdisciplinary collaboration between scientists and clinicians, which match together the achievements of surgery, immunology, and radiation diagnostics. After transplantation the complications appear, which can be associated with status of the graft, the immunological factors of compatibility between the donor and the recipient, the surgical intervention. Early diagnosis and forehanded treatment of such complications is important, as it helps to evaluate and predict the functionality of the graft. In this article we discuss the complications after kidney transplantation: the reasons of their occurrence, pathogenesis, clinical features, and radiation imaging signs. The opportunities of the radiology methods for the differential diagnostics of complications which appear before, during or after the surgery, are shown. We pay the main attention to the nuclear medicine methods, especially the dynamic renal scintigraphy (DRSG) as a method for the evaluation of graft functionality. This is a safe, accessible and non-invasive method for evaluation the quantitative and qualitative parameters of kidney function. DRSG consequently characterizes the perfusion, the extraction and the excretion in the studied organ. We display the standard DRSG protocols using [99mTc] Tc-MAG3 and [99mTc] Tc-DTPA radiopharmaceuticals. We analyze investigations of kinetic perfusion and parenchymal DRSG parameters and their importance for differential diagnosis of complications, prognosis on delayed and slow graft function, short-term and long-term graft functionality assessment. We make an accent on the prognostic importance of the dynamic changes visible on DRSG. We discuss the perspectives of further development of scintigraphic methods for the assessment of kidney grafts. It is related to the implementation of high-quality 3-dimentional visualization, newest radiopharmaceuticals. We conclude the importance of the nuclear medicine as an element of multidisciplinary approach in transplantology.

Cold Ischemia Time as a Risk Factor for Graft Dysfunction Types in Kidney Transplant Recipients.

Introduction: Cold Ischemia time (CIT) could be informative regarding the possibility of slow graft function (SGF) or delayed graft function (DGF). We aim to determine the incidence of graft dysfunction types and the association with ischemia time. Material and Methods: We performed a prospective study on 54 adults KT recipients, transplanted between 1 of January 2019 and 31 of December 2019. Graft was defined and classified into three categories: immediate graft function (IGF), SGF, and DGF. Cox regression analysis has been used to identify risk factors for graft dysfunction. Results: According to multivariate Cox regression analysis, it was observed that CIT [HR = 1.004, 95%CI = 1.001-1.007, p = 0.007] was an independent risk factor for the occurrence of graft dysfunction, while the brain death donor [HR = 11.94, 95%CI = 0.73-194.94, p = 0.08] and diabetes [HR = 2.71, 95%CI = 0.083-8.80, p = 0.09] had a trend of association with the followed outcome. In two separate models of multivariate we found that CIT was an independent risk factor for DGF [HR = 1.003, 95%CI = 1.001-1.006, p = 0.01], but not for SGF. Conclusion: In conclusion we found that kidney graft dysfunction types are associated with high CIT and CIT was an important risk factor for DGF, but no SGF in KT recipients.

Association between peri-transplant acid-base parameters and graft dysfunction types in kidney transplantation.

Perioperative acid-base disturbance could be informative regarding the possible slow graft function (SGF) or delayed graft function (DGF) development. There is a lack of data regarding the relationship between perioperative acid-base parameters and graft dysfunction in kidney transplant (KT) recipients. We aim to determine the incidence of graft dysfunction types and the association between them and acid-base parameters. We performed a prospective, cohort study on 54 adults, KT recipients, between 1st of January 2019 and 31st of December 2019. Graft function was defined and classified in three categories: immediate graft function (IGF) (serum creatinine < 3 mg/dL at day 5 after KT), SGF (serum creatinine ≥ 3mg/dL at day 5 or ≥ 2.5mg dL at day 7 after KT) and DGF (the need for at least one dialysis treatment in the first week after kidney transplantation). Among the 54 KT recipients, the incidence of SGF and DGF was 13% and 11.1%, respectively. SGF was significantly associated with lower intraoperative pH (7.26± 0.05 vs 7.35± 0.06, p= 0.004), preoperative and intraoperative base excess (BE) [-7.0 (-10.0 ߝ -6.0) vs -3.4 (-7.8 ߝ - 2.1) mmol/L, p= 0.04 and -10.3 (-11.0 ߝ -9.1) vs -4.0 (-6.3 ߝ - 3.0) mmol/L, p= 0.002, respectively] and serum bicarbonate (HCO3-) (16.0± 2.7 vs 19.3± 3.4 mmol/L, p= 0.01 and 14.1± 1.9 vs 18.8± 3.2 mmol/L, p= 0.002 respectively), compared to IGF. DGF was significantly associated with lower intraoperative values of pH (7.27± 0.05 vs 7.35± 0.06, p= 0.003), BE [-7.1 (-10.9 ߝ -6.1) vs -4.0 (-6.3 ߝ - 3.0) mmol/L, p= 0.02] and HCO3- (15.9± 2.4 vs 18.8± 3.2 mmol/L, p=0.02) compared to IGF. No differences were observed between SGF and DGF patients in any of the perioperative acid-base parameters. In conclusion we found that kidney graft dysfunction types are associated with perioperative acid-base parameters and perioperative metabolic acidosis could provide important information to predict SGF or DGF occurrence.

Predictive Value of Camera-based Donor Glomerular Filtration Rate Estimation on the Immediate Renal Allograft Outcome Following Live-related Renal Transplant: A Single-center Retrospective Study.

The purpose of this study was to assess the association of measured glomerular filtration rate (mGFR) using camera-based method with early transplant outcomes. Diethylenetriamine pentaacetate renograms of all voluntary kidney donors between January 2016 and December 2022 at Kasturba Hospital, Manipal, India, were retrieved for the study. Recipients' posttransplant biochemical parameters were collected and compared against donors with scaled mGFR >80 ml/min/1.73 m2 (Group 1) and with mGFR between 60 and 80 ml/min/1.73 m2 (Group 2). Donor-recipient pair age, anthropometric parameters, and their differences were also assessed against the immediate transplant outcome. Posttransplant immediate graft function was assessed by posttransplant nadir serum creatinine, day to achieve nadir serum creatinine, the incidence of slow graft or delayed graft function, and serum creatinine at 1-month posttransplantation. Recipients with serum creatinine of >2.5 mg/dl on posttransplant day 7 were taken as slow graft function. A total of 161 donor-recipient pairs were analyzed in the study. In recipients who showed persistently high serum creatinine posttransplant, older donor age(p < 0.001), higher difference in body mass index among the donor-recipient pair (p= 0.03), and mGFR <80ml/min (p < 0.001) were significantly associated. Slow graft function was significantly more in Group II recipients, with donors having mGFR <80ml/min as compared to Group I with mGFR >80 ml/min (37.3% vs. 10.6%) (P < 0.001). Camera-based mGFR using Gates' formula is a reliable tool to predict inferior graft outcomes in the immediate posttransplant period. Kidneys from donors with mGFR of 60-80 mL/min/1.73 m2 are likely to experience slow graft function in the immediate posttransplant period.

An analysis of the relationship between donor and recipient biomarkers and kidney graft function, dysfunction, and rejection

BackgroundThe study aimed to find predictive biomarkers to evaluate donor kidney function to predict graft dysfunction as well as to assess an early signs of acute graft rejection. MethodTwenty-seven deceased donors and 54 recipients who underwent a successful kidney transplantation were enrolled in the study. An assessment was made in serum and urine from donors and recipients to measure the following biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase 2 (TIMP-2) and urinary N-acetyl-b-D-glucosaminidase (uNAG). These biomarkers were used to establish a model for predicting a reduced graft function (RGF) classified as either a delayed or slow graft function. ResultOur analysis suggest that out of four tested biomarkers, the serum TIMP-2 and uNAG levels of the donors had a predictive value for RGF; the area under the receiver operating characteristic curves (AUROC) of serum TIMP-2 and uNAG were 0.714 and 0.779, respectively. The combined best fitting prediction model of serum TIMP-2, uNAG, and creatinine levels was better in predicting RGF than the serum creatinine level alone. In addition, the recipient serum TIMP-2 level on the third day post-transplantation (D3) was associated with the estimated glomerular filtration rate (eGFR) on the seventh day post-transplantation (D7; OR 1.119, 95% CI 1.016–1.233, p = 0.022). Furthermore, the ROC curve value revealed that the AUROC of TIMP-2 on D3 was 0.99 (95% CI 0.97–1, p < 0.001), and this was the best predictive value of the renal function on D7. ConclusionsDonor serum TIMP-2 and uNAG levels are useful predictive biomarkers because they can provide the donor-based prediction for RGF.

Clinical outcomes for kidney transplantation in 81 adults with IgA nephropathy.

Immunoglobulin A nephropathy (IgAN) is one of the most common types of kidney disease, and kidney transplantation is the most effective treatment for end-stage renal disease. This study aims to analyze the clinical curative effect of renal transplantation for adults with IgAN and to discuss the efficacy and safety of kidney transplantation for IgAN at the perioperative period and medium- and long-term follow-up. This retrospective study included the clinical and follow-up data of 81 adult patients with IgAN who underwent kidney transplantation at the Second Xiangya Hospital, Central South University from January 2018 to January 2022. Of the 81 patients whose age at (34.1±9.9) years old, 47 (58.0%) were male. The body mass index was (20.8±3.2) kg/m2, and the human leukocyte antigen (HLA) mismatch number was 3.5±1.2. The estimated glomerular filtration rate (eGFR) and daily 24-hour urine output for the recipients on the 1st, 5th, and 7th day after kidney transplantation and when they were discharged were analyzed. The recovery of the transplanted kidney and occurrence of complications were comprehensively evaluated. The eGFR, urinary protein, and occult blood were evaluated at the 6th, 12th, 24th, 36th, and 48th month and at the last follow-up. The follow-up time was (25.7±15.8) months. No primary non-function occurred in any patient during the perioperative period time. Fifty-one (63.0%) patients had immediate graft function recovery, and 16 (19.8%) patients had slow graft function recovery. Delayed recovery of graft function was observed in 14 (17.3%) patients. A total of 19 perioperative complications occurred, including 9 patients with acute rejection, 5 patients with urinary fistula, 1 thrombosis in both lower limbs, and 4 lymphatic fistula. The eGFR at 6th, 12th, 24th, 36th, and 48th month of follow-up were (65.3±22.9), (67.6±23.0), (64.3±21.8), (65.9±24.7), and (68.7±31.2) mL/(min·1.73 m2), respectively. The eGFR remained high during the medium- and long-term follow-ups. At the longest follow-up of 56 months, eGFR fluctuation was still mild, and the positive rate of urine protein and occult blood was low. IgAN recurred in 4 transplanted kidneys, accounting for 4.94% of the total patients, without severe renal insufficiency. Three patients had kidney dysfunction due to severe pneumonia, rejection, and stone in the transplanted kidney. The overall survival rate of the transplanted kidney was higher than 95%, and the survival rate of all patients was 100% till Januray 2022. Renal transplantation for adults with IgAN had a remarkable short-term effect. The recipients can be beneficial significantly to favorable midium- and long-term outcomes. IgAN recurrence is infrequent and rarely causes severe renal function damage.

Prevalence and Impact of BK Polyomavirus in the Ureters of Kidney Donors: Research Letter.

More than 75% of the population is seropositive for BK polyomavirus (BKV), which remains quiescent in the urothelium in immunocompetent hosts. However, it can reactivate in kidney transplant recipients (KTRs), and up to 30% of them will develop BKV viremia in the 2 years following transplant, with a risk of developing BKV-associated nephropathy (BKVAN). Viral reactivation is associated with the level of immunosuppression, but there is currently no way to predict which patients are at high risk for reactivation. As BKV originates from kidney donors, our primary objective was to determine the prevalence of detectable BKV in donor ureters. Our secondary objective was to see if there is a correlation between the presence of BKV in donor urothelium and the development of BKV viremia and BKVAN in KTR. Prospective cohort study. Single-center academic kidney transplant program. Prospective sequential KTRs that received a kidney transplant between March 2016 and March 2017. The presence of BKV in donor ureters was determined by TaqMan-based quantitative polymerase chain reaction (PCR; qPCR). We performed a prospective study which was done on 35 out of the 100 donors initially foreseen to take part in the study. During surgery, the distal part of donor ureter was kept and analyzed by qPCR (to establish the presence of BKV in the urothelium). The primary outcome was the development of BKV viremia in KTR over a period of 2 years after transplant. Secondary outcome was the development of BKVAN. Out of 35 ureters analyzed, only one had a positive qPCR for BKV (2.86%, 95% confidence interval [CI]: [0.07-14.92]). Considering the primary objective would not be met, the study was interrupted after 35 specimens. After surgery, 9 recipients had a slow graft function and 4 had delayed graft function, one of which never recovered graft function. Over the 2-year follow-up, 13 patients developed BKV viremia, while 5 patients developed BKVAN. The patient who received a graft from a positive qPCR donor eventually developed BKV viremia and nephropathy. The specimen analyzed was a distal rather than a proximal portion of the ureter. However, BKV replication is known to concentrate in the corticomedullary junction. BK polyomavirus prevalence in the distal part of donor ureters is lower than previously reported. It cannot be used as a predictor for the development of BKV reactivation and/or nephropathy.

185: VASOPRESSOR EXPOSURE IS ASSOCIATED WITH POOR ALLOGRAFT FUNCTION IN LIVING DONOR RENAL TRANSPLANTS

Introduction: Negative outcome studies of vasopressors in kidney transplant have not focused on the living donor renal transplant recipient population. Methods: The evaluation sought to investigate the independent impact of perioperative vasopressors on postoperative renal allograft function in a sample representing the living donor renal transplant recipient population at our center. This was a retrospective, observational, single-center evaluation of patients > 18 years old who underwent living donor kidney transplantation comparing outcomes based on vasopressor exposure. Results: The study included 71 patients of which 27 (38%) received perioperative vasopressors. The primary outcome differed between groups with poor graft function (delayed or slow graft function) occurring in 7 (27%) versus 1(2.4%) occurring more often in those that received perioperative vasopressors (P = 0.004). The immediate (2.28 vs 1.47mg/dL, P = 0.006) and discharge (2.3 vs. 1.57, P=0.006) SCr was higher, with worse immediate eGFR (44.7 vs. 60.4mL/min/1.73m2, P = 0.021) and discharge eGFR (45 vs. 60.1mL/min/1.73m2, P = 0.021) in patients who received vasopressors. Stepwise backward logistical regressions identified only perioperative vasopressors as being associated with poor graft function. Patients exposed to vasopressors were 10.6 times more likely to develop delayed or slow graft function (P = 0.04). Patients that were exposed to vasopressors more often experienced arrhythmias (29.6% vs. 4.5%, P = 0.003). Conclusions: The use of perioperative vasopressors was independently associated with worsened early renal allograft function including delayed graft function and adverse events. Further investigation is needed to identify risk factors for the utilization of vasopressors in the living donor renal transplant recipient population.

Clinical Outcomes of Transplanted Kidneys from Deceased Donors Using Different Generic Preservation Solutions.

Background and Objectives: StoreProtect Plus® is a preserving solution for cold organ storage, with a composition identical to Institute Georges Lopez (IGL-1) solution. The aim of this single center study was to compare the clinical performance of StoreProtect Plus with the generic counterpart of University of Wisconsin preservation fluid, named SPS-1®. Materials and Methods: The clinical outcomes of 168 consecutive organs preserved with StoreProtect Plus solution and 167 organs preserved with SPS-1 solution were compared. During an 18-month post-transplant follow-up period, kidney graft function, the frequency of acute rejection, post-transplant diabetes, and infectious complications, as well as patient and graft survival were analyzed. Results: There was significantly more immediate graft function (IGF) (39.3 vs. 24.0%; p &lt; 0.01) and less slow graft function (SGF) (38.7 vs. 51.5%; p &lt; 0.05) in the StoreProtect Plus group in comparison with the SPS-1 group, whereas the occurrence of DGF was similar in both groups. Long-term kidney graft function was comparable. Multivariate regression analysis showed that the use of StoreProtect Plus vs. SPS-1 solution (rpartial = 0.217; p &lt; 0.001) and the amount of residual diuresis (rpartial = 0.147; p &lt; 0.001) independently increased the occurrence of IGF, whereas Scr &gt; 1.5 mg/dL prior to organ procurement (rpartial = -0.198; p &lt; 0.001), longer CIT (rpartial = -0.170; p &lt; 0.01), and CVD donor death (rpartial = -0.214; p &lt; 0.001) were associated with SGF. Conclusions: The higher occurrence of IGF was found in kidney transplant recipients whose organs were preserved using StoreProtect Plus solution as compared with SPS-1 solution. The two groups did not differ in kidney graft function, the frequency of post-transplant complications, as well as patient and graft survival.

An enhanced level of VCAM in transplant preservation fluid is an independent predictor of early kidney allograft dysfunction.

BackgroundWe aimed to evaluate whether donor-related inflammatory markers found in kidney transplant preservation fluid can associate with early development of kidney allograft dysfunction.MethodsOur prospective study enrolled 74 consecutive donated organs who underwent kidney transplantation in our center between September 2020 and June 2021. Kidneys from 27 standard criteria donors were allocated to static cold storage and kidneys from 47 extended criteria donors to hypothermic machine perfusion. ELISA assessment of inflammatory biomarkers (IL-6, IL6-R, ICAM, VCAM, TNFα, IFN-g, CXCL1 and Fractalkine) was analyzed in view of a primary endpoint defined as the occurrence of delayed graft function or slow graft function during the first week following transplantation.ResultsSoluble VCAM levels measured in transplant conservation fluid were significantly associated with recipient serum creatinine on day 7. Multivariate stepwise logistic regression analysis identified VCAM as an independent non-invasive predictor of early graft dysfunction, both at 1 week (OR: 3.57, p = .04, 95% CI: 1.06-12.03) and 3 Months (OR: 4.039, p = .034, 95% CI: 1.11-14.73) after transplant surgery.ConclusionsThis prospective pilot study suggests that pre-transplant evaluation of VCAM levels could constitute a valuable indicator of transplant health and identify the VCAM-CD49d pathway as a target to limit donor-related vascular injury of marginal transplants.

Clinical indicators of slow graft function and outcome after pediatric kidney transplantation.

Lesser degrees of perioperative ischemia-reperfusion injury that does not require dialysis may nonetheless influence allograft outcomes, necessitating evaluation of suitable surrogate indicators of perioperative allograft injury. This retrospective analysis of pediatric kidney transplants evaluated two indicators representing pace and completeness of recovery, for association with 12-month estimated glomerular filtration rate (eGFR) and first-year rate of eGFR decline: time to creatinine nadir (TTN) and ratio of recipient/donor unadjusted GFR (uGFRR/D ) at 1-month post-transplant. Donor, recipient, and perioperative risk factors were tested further for association with these 2 indicators. 179 patients (190 transplants) aged 13 (IQR 7-17) years and 56% male were included. Twelve-month eGFR was strongly associated with unadjusted GFR at 1 month (uGFR1M , p < .001) and uGFRR/D (p=.003), but not with TTN. None of the indicators was associated with the rate of subsequent eGFR decline after 1-month post-transplant. As a potential surrogate indicator, uGFR1M is effectively modeled by TTN and uGFRR/D (adjusted R2 =0.57) and is associated with 12-month eGFR (β=0.81 ± 0.08; p < .001). Clinical factors associated with uGFRR/D included donor uGFR (p < .001), BSA (p=.026), age (p=.074), and recipient BSA (p < .001). Factors associated with pace of recovery (TTN) included donor uGFR (p=.018), type (p=.019), and recipient BSA (p=.022). The uGFRR/D ratio, but not TTN, is a useful indicator of perioperative allograft damage that is associated with one-year functional outcome; and uGFR1M is a potential early surrogate outcome. Donor, recipient, and perioperative factors that are associated with slow allograft function are identified.