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Zhang H, Fu Q, Liu J, Li J, Deng R, Wu C, Nie W, Chen X, Liu L, Wang C. Risk factors and outcomes of prolonged recovery from delayed graft function after deceased kidney transplantation. Ren Fail 2021; 42:792-798. [PMID: 32772773 PMCID: PMC7472517 DOI: 10.1080/0886022x.2020.1803084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective We aimed to evaluate the effect of prolonged recovery from DGF on outcomes, using a new definition of DGF recovery time, among deceased donor kidney transplant recipients with DGF, and to examine the risk factors for prolonged recovery. Methods From 2007 to 2016, 91 deceased donor kidney transplant recipients with DGF were retrospectively analyzed. DGF recovery time was defined as the time from transplantation to achieve a stable estimated glomerular filtration rate (eGFR). Recipients with a DGF recovery time greater than or equal to the median were assigned to the prolonged recovery group, while the others were assigned to the rapid recovery group. Result The median DGF recovery time was 27 days. Donor terminal eGFR was significantly lower in the prolonged recovery group (n = 46) compared with the rapid recovery group (n = 45) (median 24.9 vs. 65.4 ml/min/1.73m2, p = 0.004). The eGFR at 1 year post-transplant in the prolonged recovery group was significantly lower than that in the rapid recovery group (50.6 ± 20.0 vs. 63.5 ± 21.4 ml/min/1.73m2, p = 0.005). The risk of adverse outcomes (acute rejection, pneumonia, graft failure, and death) was significantly greater in the prolonged recovery group (hazard ratio 2.604, 95% confidence interval 1.102–6.150, p = 0.029) compared with the rapid recovery group. Conclusion Decreased donor terminal eGFR is a risk factor for prolonged recovery from DGF after deceased kidney transplantation. Prolonged DGF recovery time is associated with reduced graft function at 1-year post-transplant, and poor transplant outcome.
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Affiliation(s)
- Huanxi Zhang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinqi Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ronghai Deng
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weijian Nie
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xutao Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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The recovery status from delayed graft function can predict long-term outcome after deceased donor kidney transplantation. Sci Rep 2017; 7:13725. [PMID: 29057921 PMCID: PMC5651849 DOI: 10.1038/s41598-017-14154-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/06/2017] [Indexed: 12/17/2022] Open
Abstract
The effect of delayed graft function (DGF) recovery on long-term graft outcome is unclear. The aim of this study was to examine the association of DGF recovery status with long-term outcome. We analyzed 385 recipients who underwent single kidney transplantation from brain-dead donors between 2004 and 2015. Patients were grouped according to renal function at 1 month post-transplantation: control (without DGF); recovered DGF (glomerular filtration rate [GFR] ≥ 30 mL/min/1.73 m2); and incompletely recovered DGF group (GFR < 30 mL/min/1.73 m2). DGF occurred in 104 of 385 (27%) recipients. Of the DGF patients, 70 recovered from DGF and 34 incompletely recovered from DGF. Death-censored graft survival rates for control, recovered DGF, and incompletely recovered DGF groups were 95.3%, 94.7%, and 80.7%, respectively, at 5 years post-transplantation (P = 0.003). Incompletely recovered DGF was an independent risk factor for death-censored graft loss (HR = 3.410, 95%CI, 1.114-10.437). DGF was associated with increased risk for patient death regardless of DGF recovery status. Mean GFRs at 5 years were 65.5 ± 20.8, 62.2 ± 27.0, and 45.8 ± 15.4 mL/min/1.73 m2 for control, recovered, and incompletely recovered DGF groups, respectively (P < 0.001). Control group and recovered DGF patients had similar renal outcomes. However, DGF was associated with increased risk for patient death regardless of DGF recovery status.
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McMahon BA, Koyner JL, Novick T, Menez S, Moran RA, Lonze BE, Desai N, Alasfar S, Borja M, Merritt WT, Ariyo P, Chawla LS, Kraus E. The prognostic value of the furosemide stress test in predicting delayed graft function following deceased donor kidney transplantation. Biomarkers 2017; 23:61-69. [PMID: 29034718 DOI: 10.1080/1354750x.2017.1387934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES AND METHODS The Furosemide Stress Test (FST) is a novel dynamic assessment of tubular function that has been shown in preliminary studies to predict patients who will progress to advanced stage acute kidney injury, including those who receive renal replacement therapy (RRT). The aim of this study is to investigate if the urinary response to a single intraoperative dose of intravenous furosemide predicts delayed graft function (DGF) in patients undergoing deceased donor kidney transplant. RESULTS On an adjusted multiple logistic regression, a single 100 mg dose of intraoperative furosemide after the anastomosis of the renal vessels (FST) predicted the need for RRT at 2 and 6 h post kidney transplantation (KT). Recipient urinary output was measured at 2 and 6 h post furosemide administration. In receiver-operating characteristic (ROC) analysis, the FST predicted DGF with an area-under-the curve of 0.85 at an optimal urinary output cut-off of <600 mls at 6 h with a sensitivity of and a specificity of 83% and 74%, respectively. CONCLUSIONS The FST is a predictor of DGF post kidney transplant and has the potential to identify patients requiring RRT early after KT.
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Affiliation(s)
- Blaithin A McMahon
- a Division of Nephrology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jay L Koyner
- b Section of Nephrology, Department of Medicine , University of Chicago , Chicago , IL , USA
| | - Tessa Novick
- a Division of Nephrology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Steve Menez
- a Division of Nephrology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Robert A Moran
- c Division of Gastroenterology, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Bonnie E Lonze
- d Comprehensive Renal Transplantation Unit , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Niraj Desai
- d Comprehensive Renal Transplantation Unit , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Sami Alasfar
- a Division of Nephrology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,d Comprehensive Renal Transplantation Unit , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Marvin Borja
- d Comprehensive Renal Transplantation Unit , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - William T Merritt
- e Johns Hopkins Anesthesiology and Critical Care Medicine , Baltimore , MD , USA
| | - Promise Ariyo
- e Johns Hopkins Anesthesiology and Critical Care Medicine , Baltimore , MD , USA
| | - Lakhmir S Chawla
- f Department of Medicine, Division of Intensive Care Medicine and Division of Nephrology , Veterans Affairs Medical Center , Washington DC , USA
| | - Edward Kraus
- a Division of Nephrology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,d Comprehensive Renal Transplantation Unit , Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Hollmen ME, Kyllönen LE, Merenmies J, Salmela KT. Serum neutrophil gelatinase-associated lipocalin and recovery of kidney graft function after transplantation. BMC Nephrol 2014; 15:123. [PMID: 25066815 PMCID: PMC4122536 DOI: 10.1186/1471-2369-15-123] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 07/03/2014] [Indexed: 01/18/2023] Open
Abstract
Background Neutrophil gelatinase-associated lipocalin (NGAL) is a marker for acute kidney injury. We studied whether serum NGAL predicts delayed graft function (DGF) and recovery of kidney function after transplantation. Methods Serum NGAL was analyzed using commercial ELISA and point-of-care (POC) (Triage®, Biosite) methods. Serum samples were collected from 176 consecutive, deceased-donor kidney recipients just before transplant surgery and on day 1 and 14 after transplantation. The first 132 samples were analyzed with both methods and the remaining samples with the POC method. Results The correlation between the ELISA and POC methods was 0.89, p < 0.0001 and hence the POC method was used for the remaining analyses. DGF was seen in 66/176 patients. Day 1 sNGAL was significantly higher in DGF (588 ng/ml, SD 189.6) compared to early graft function (355 ng/ml, SD 166.2, p < 0.0001) and this difference persisted on day 14. Day 1 sNGAL predicted DGF with an area under the curve (AUC) of 0.853 (CI 0.792-0.914, p < 0.0001). At the optimal cutoff level of 423 ng/ml the sensitivity was 87% and the specificity 77%. In a multivariate analysis, day 1 sNGAL emerged as an independent predictor of DGF. The sNGAL also predicted DGF lasting longer than 14 days with an AUC of 0.825 (CI 0.751-0.899, p < 0.0001). At the optimal cutoff level of 486 ng/ml, the sensitivity was 80% and specificity 75%. Conclusion Serum NGAL predicts clinically significant DGF and is useful in the care of kidney transplant recipients.
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Affiliation(s)
- Maria E Hollmen
- Department of Medicine, Division of Nephrology, Helsinki University Hospital, Haartmaninkatu 4, PL 372, Helsinki 00029, HUS, Finland.
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Field M, Dronavalli V, Mistry P, Drayson M, Ready A, Cobbold M, Inston N. Urinary biomarkers of acute kidney injury in deceased organ donors - kidney injury molecule-1 as an adjunct to predicting outcome. Clin Transplant 2014; 28:808-15. [DOI: 10.1111/ctr.12383] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie Field
- Department of Renal Transplantation; University Hospital Birmingham Foundation Trust; Birmingham UK
- MRC Centre for Immune Regulation; School of Immunity and Infection; Medical School; University of Birmingham; Birmingham UK
| | - Vamsi Dronavalli
- Department of Cardiothoracic Surgery; University Hospital Birmingham Foundation Trust; Birmingham UK
| | - Punam Mistry
- MRC Centre for Immune Regulation; School of Immunity and Infection; Medical School; University of Birmingham; Birmingham UK
| | - Mark Drayson
- MRC Centre for Immune Regulation; School of Immunity and Infection; Medical School; University of Birmingham; Birmingham UK
| | - Andrew Ready
- Department of Renal Transplantation; University Hospital Birmingham Foundation Trust; Birmingham UK
| | - Mark Cobbold
- MRC Centre for Immune Regulation; School of Immunity and Infection; Medical School; University of Birmingham; Birmingham UK
| | - Nicholas Inston
- Department of Renal Transplantation; University Hospital Birmingham Foundation Trust; Birmingham UK
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Marek C, Thomson B, Shoker A, Luke PP, Moser MAJ. The prognostic value of time needed on dialysis in patients with delayed graft function. Nephrol Dial Transplant 2013; 29:203-8. [PMID: 24166459 DOI: 10.1093/ndt/gft412] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We hypothesize that in patients with delayed graft function (DGF), the need for a longer time needed on dialysis (TND) post-kidney transplant is associated with poorer long-term function and an increase in complications. METHODS This was a retrospective chart review involving collaboration between Western University (WU) Renal Transplant Program of London, Ontario and the Saskatchewan renal transplant program (SRTP). A total of 774 patients (567 WU and 207 SRTP) received kidney transplants between 2004 and 2011, of which 83 patients with deceased donor transplants (59 WU and 24 SRTP) developed DGF, defined as the need for dialysis in the first week posttransplant. RESULTS Patients with DGF were divided into three groups depending on TND [group 1: <7 days (n = 52), group 2: 7-14 days (n = 13) and group 3 (n = 18): >14 days]. The creatinine clearance (CrCl) at 30 days (42.5, 33.8, 20.0 cc/min; P < 0.001) and 1 year (56.7, 49.2, 37.3 cc/min, P = 0.031) were significantly different between the three groups. Multivariate regression analysis identified length of TND posttransplant (β = -0.5, P < 0.001) and donation after cardiac death (DCD) donor (β = 19.5, P < 0.001) as the most significant predictors of CrCl at 1 year in these patients with DGF. DCD kidneys with DGF had a higher CrCl at 1 year and fewer readmissions in the first year compared with non-DCD kidneys with DGF. DISCUSSION Our study suggests that increased TND is associated with worse CrCl at 1 year. The data also support the hypothesis of a different mechanism for DGF in DCD and non-DCD kidneys.
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Affiliation(s)
- Caitlyn Marek
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
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Jayaram D, Kommareddi M, Sung RS, Luan FL. Delayed graft function requiring more than one-time dialysis treatment is associated with inferior clinical outcomes. Clin Transplant 2012; 26:E536-43. [DOI: 10.1111/ctr.12029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Deepa Jayaram
- Internal Medicine; Division of Nephrology; University of Michigan; Ann Arbor; MI; USA
| | - Mallika Kommareddi
- Internal Medicine; Division of Nephrology; University of Michigan; Ann Arbor; MI; USA
| | - Randall S. Sung
- Surgery; Division of Transplantation; University of Michigan; Ann Arbor; MI; USA
| | - Fu L. Luan
- Internal Medicine; Division of Nephrology; University of Michigan; Ann Arbor; MI; USA
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Deceased donor neutrophil gelatinase-associated lipocalin and delayed graft function after kidney transplantation: a prospective study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R121. [PMID: 21545740 PMCID: PMC3218974 DOI: 10.1186/cc10220] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 03/03/2011] [Accepted: 05/05/2011] [Indexed: 12/13/2022]
Abstract
Introduction Expanding the criteria for deceased organ donors increases the risk of delayed graft function (DGF) and complicates kidney transplant outcome. We studied whether donor neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker for acute kidney injury, could predict DGF after transplantation. Methods We included 99 consecutive, deceased donors and their 176 kidney recipients. For NGAL detection, donor serum and urine samples were collected before the donor operation. The samples were analyzed using a commercial enzyme-linked immunosorbent assay kit (serum) and the ARCHITECT method (urine). Results Mean donor serum NGAL (S-NGAL) concentration was 218 ng/mL (range 27 to 658, standard deviation (SD) 145.1) and mean donor urine NGAL (U-NGAL) concentration was 18 ng/mL (range 0 to 177, SD 27.1). Donor S-NGAL and U-NGAL concentrations correlated directly with donor plasma creatinine levels and indirectly with estimated glomerular filtration rate (eGFR) calculated using the modification of diet in renal disease equation for glomerular filtration rate. In transplantations with high (greater than the mean) donor U-NGAL concentrations, prolonged DGF lasting longer than 14 days occurred more often than in transplantations with low (less than the mean) U-NGAL concentration (23% vs. 11%, P = 0.028), and 1-year graft survival was worse (90.3% vs. 97.4%, P = 0.048). High U-NGAL concentration was also associated with significantly more histological changes in the donor kidney biopsies than the low U-NGAL concentration. In a multivariate analysis, U-NGAL, expanded criteria donor status and eGFR emerged as independent risk factors for prolonged DGF. U-NGAL concentration failed to predict DGF on the basis of receiver operating characteristic curve analysis. Conclusions This first report on S-NGAL and U-NGAL levels in deceased donors shows that donor U-NGAL, but not donor S-NGAL, measurements give added value when evaluating the suitability of a potential deceased kidney donor.
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Urine neutrophil gelatinase-associated lipocalin is a marker of graft recovery after kidney transplantation. Kidney Int 2011; 79:89-98. [DOI: 10.1038/ki.2010.351] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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