Association of pre-transplant statin use with delayed graft function in kidney transplant recipients

Risk factors for delayed graft function in patients with kidney transplantation: a systematic review and meta-analysis

BACKGROUND

Delayed graft function (DGF) continues to represent one of the most frequently encountered early complications following kidney transplantation. Despite notable progress in donor and recipient pretreatment protocols, diagnostic techniques and therapeutic approaches, the incidence of DGF, along with its associated short- and long-term sequelae, has not demonstrated a significant reduction. DGF is influenced by a multitude of factors, and individuals with exposure to these risk factors exhibit a markedly increased probability of developing DGF.

OBJECTIVES

To systematically identify and evaluate risk factors associated with DGF in kidney transplant recipients.

DESIGN

A systematic review and meta-analysis DATA SOURCES: A comprehensive search was performed across multiple databases, including PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP and SinoMed, from the inception of each database until 1 March 2024.

PRIMARY OUTCOME MEASURES

OR and OR 95% CI of risk factors for DGF.

RESULTS

The meta-analysis included 19 studies involving a total of 153 008 patients, of whom 96 596 (63.1%) developed DGF. The following risk factors for DGF were identified: prolonged cold ischaemia time (CIT) (OR=1.05, 95% CI=1.03 to 1.07, p<0.0001), elevated donor end-stage serum creatinine (OR=1.54, 95% CI=1.26 to 1.87, p<0.0001), extended dialysis vintage (OR=1.02, 95% CI=1.00 to 1.02, p=0.014), increased human leucocyte antigen (HLA) mismatch number (OR=1.19, 95% CI=1.06 to 1.33, p=0.004), higher donor body mass index (BMI) (OR=1.07, 95% CI=1.03 to 1.11, p<0.0001), advanced donor age (OR=1.02, 95% CI=1.01 to 1.03, p=0.003) and recipient diabetes mellitus (OR=1.52, 95% CI=1.40 to 1.64, p<0.0001).

CONCLUSION

This meta-analysis identified seven significant risk factors for DGF, including prolonged CIT, elevated donor end-stage serum creatinine, extended dialysis vintage, increased HLA mismatch number, higher donor BMI, advanced donor age and recipient diabetes mellitus. These findings may offer potential insights for developing clinical strategies to mitigate the risk of DGF in kidney transplant recipients and improve postoperative management.

PROSPERO REGISTRATION NUMBER

CRD42024520542.

The Impact of Hematological Indices on the Occurrence of Delayed Graft Function (DGF) of Transplanted Kidney

BACKGROUND

to analyse the effect of haematological indices on the occurrence of Delayed Graft Function (DGF) in patients undergoing kidney transplantation and on the function of the transplanted kidney on the 7th postoperative day.

METHODS

365 recipients who underwent kidney transplantation from a donor with known brain death between 2010 and 2017 were included in this retrospective study. Information from patient medical records, donor medical records, and donation and transplantation protocols was used for analysis. Statistica 13 was used for statistical analysis.

RESULTS

In the study group, DGF occurred in 144 recipients (39.45%), and Non-Graft Function (NGF) occurred in 12 recipients (3.29%). Recipients who developed DGF had a significantly higher Neutrophil/Monocyte Ratio (NMR) before renal transplantation (p = 0.048), a lower NMR value on postoperative day 1 (p < 0.001), and a difference between the values on day 1 and before surgery (p < 0.001). In addition, they had a significantly lower Lymphocyte/Monocyte Ratio (LMR) on postoperative day 1 LMR 1 (p < 0.001). It was shown that the value of the indices based on the ROC curve-NMR1 > 29.29, NMR1-0 > 22.71, and LMR1 > 1.74 (respectively: AUC = 0.624; 95% CI 0.566-0.682; and p < 0.001/AUC = 0.622; 95% CI 0.563-0.680; and p < 0.001/AUC = 0.610; 95% CI 0.550-0.670; and p < 0.001)-can be used to identify recipients with a significant probability of DGF.

CONCLUSIONS

the NMR and LMR parameters on the first postoperative day and the difference between the NMR values on the first post-transplant day and the first pre-transplant day are predictive factors associated with the risk of DGF.

Acute Kidney Injury, Microvascular Rarefaction, and Estimated Glomerular Filtration Rate in Kidney Transplant Recipients

BACKGROUND AND OBJECTIVES

Animal studies suggest that microvascular rarefaction is a key factor in the acute kidney disease to CKD transition. Hence, delayed graft function appears as a unique human model of AKI to further explore the role of microvascular rarefaction in kidney transplant recipients. Here, we assessed whether delayed graft function is associated with peritubular capillary loss and evaluated the association between this loss and long-term kidney graft function.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This observational, retrospective cohort study included 61 participants who experienced delayed graft function and 130 who had immediate graft function. We used linear regression models to evaluate associations between delayed graft function and peritubular capillary density expressed as the percentage of efficient cortical area occupied by peritubular capillaries in pre- and post-transplant graft biopsies. eGFRs 1 and 3 years post-transplant were secondary outcomes.

RESULTS

Post-transplant biopsies were performed at a median of 113 days (interquartile range, 101-128) after transplantation. Peritubular capillary density went from 15.4% to 11.5% in patients with delayed graft function (median change, -3.7%; interquartile range, -6.6% to -0.8%) and from 19.7% to 15.1% in those with immediate graft function (median change, -4.5%; interquartile range, -8.0% to -0.8%). Although the unadjusted change in peritubular capillary density was similar between patients with and without delayed graft function, delayed graft function was associated with more peritubular capillary loss in the multivariable analysis (adjusted difference in change, -2.9%; 95% confidence interval, -4.0 to -1.8). Pretransplant peritubular capillary density and change in peritubular capillary density were associated with eGFR 1 and 3 years post-transplantation.

CONCLUSIONS

Perioperative AKI is associated with lower density in peritubular capillaries before transplantation and with loss of peritubular capillaries following transplantation. Lower peritubular capillary density is linked to lower long-term eGFR.

Hemodialysis or Peritoneal Dialysis, Which Is Better for Patients with Delayed Graft Function?

BACKGROUND/AIMS

Hemodialysis (HD) or peritoneal dialysis (PD) is an important renal replacement method in patients with delayed graft function (DGF) after kidney transplantation; however, it is not clear which dialysis modality is superior. This study determined the impact of different dialysis modalities on patients with DGF.

METHODS

It was a single-center, retrospective and descriptive study. We performed 673 kidney transplants from donors after cardiac death (DCD) between January 2010 and December 2016 at our center and 138 (20.5%) recipients developed DGF after transplantation. We classified the recipients into two groups according to post-transplant dialysis: DGF-HD (n=96) and DGF-PD (n=42). We analyzed the outcomes of the different dialysis modalities 30 days and 1 year post-transplantation.

RESULTS

There were no differences in baseline factors between patients with post-transplant HD (n = 96) or PD (n = 42). There were 10 patients with conversion from PD to HD during DGF. The DGF-PD patients had a higher rate of treatment failure than the DGF-HD patients (23.8% vs. 0%, p < 0.001), peritonitis (7.1% vs. 0%, p = 0.027), and longer duration of dialysis dependence (10.5 vs. 9 days, p = 0.003). There was no statistically significant difference between both groups with respect to acute rejection, hemorrhage, and patient and graft survival at 1 year.

CONCLUSION

In renal transplant recipients with DGF, post-transplant PD led to increased treatment failure. PD did not result in rapid recovery of transplanted renal function, and had a high probability of peritonitis.

The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in renal disease

It is well known that statins exert their main effect by inhibiting cholesterol synthesis through the inhibition of the 3-hydroxy-3-methyl-glutaryl-CoA reductase enzyme. The pleiotropic effects of statins, which are independent of their inhibition of cholesterol synthesis, have explained many of the beneficial effects of these drugs in a variety of disorders such as malignancies, infection, and sepsis, as well as in cardiovascular and rheumatologic disorders. However, the role of these drugs in renal disorders remains controversial. In the present review, we examine the most recent findings involving statins and renal disease among different clinical scenarios, including chronic kidney disease, contrast-induced nephropathy, renal injury after coronary artery bypass surgery, and renal transplant patients.