Delayed Graft Function Has an Equally Bad Impact on Deceased Donor Renal Graft Survival in Both Standard Criteria Donors and Expanded Criteria Donors

Abstract Background and Aims Kidneys from expanded criteria donors with diagnosis of brain death have become a part of the organ transplant program, which have thus increased the number of transplants. Method In this retrospective analysis, we identified the expanded criteria donors in a group of 156 kidney donors at our center. Basic parameters of the donors before kidney recovery were collected. Graft function, graft survival, and patient survival at 1, 3, and 5 years posttransplant were compared in expanded criteria versus standard criteria donors. Results Expanded criteria donors were significantly older than standard criteria donors (P < .001), had higher body mass index (P = .006), and had more frequent arterial hypertension (P < .001) and diabetes mellitus (P = .004) in their histories. When we considered the estimated glomerular filtration rate, graft function in the first 6 months after transplant was significantly worse in kidneys from expanded criteria donors (P = .011). In addition, recipients of grafts from expanded criteria donors had significantly worse survival in the first year posttransplant (P = .023); however, no differences in graft survival were observed. Conclusion From the long-term aspect, graft function and graft and patient survival in cases of kidneys from expanded criteria donors were comparable to results with kidneys from standard criteria donors. Expanded use of organs available for transplant is important due to the constantly increasing demands versus limited offers of organs.

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Long-term effects of delayed graft function duration on function and survival of deceased donor kidney transplants

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0065 ◽

2019 ◽

Vol 41 (2) ◽

pp. 231-241 ◽

Cited By ~ 1

Author(s):

Mateus Swarovsky Helfer ◽

Jeferson de Castro Pompeo ◽

Otávio Roberto Silva Costa ◽

Alessandra Rosa Vicari ◽

Adriana Reginato Ribeiro ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Graft Function ◽

Deceased Donor ◽

Delayed Graft Function ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

Abstract Introduction: Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated. Objective: The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function. Methods: A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013. Results: The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival. Conclusions: The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.

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Pulsatile Perfusion Preservation for Expanded-Criteria Donors Kidneys: Impact on Delayed Graft Function Rate

The International Journal of Artificial Organs ◽

10.5301/ijao.2011.8458 ◽

2011 ◽

Vol 34 (6) ◽

pp. 513-518 ◽

Cited By ~ 12

Author(s):

Imad Abboud ◽

Corinne Antoine ◽

François Gaudez ◽

Fabienne Fieux ◽

Carmen Lefaucheur ◽

...

Keyword(s):

Graft Function ◽

Delayed Graft Function ◽

Expanded Criteria ◽

Expanded Criteria Donors ◽

Pulsatile Perfusion

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Degree of Glomerulosclerosis in Procurement Kidney Biopsies from Marginal Donor Kidneys and Their Implications in Predicting Graft Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm9051469 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1469

Author(s):

Wisit Cheungpasitporn ◽

Charat Thongprayoon ◽

Pradeep K Vaitla ◽

Api Chewcharat ◽

Panupong Hansrivijit ◽

...

Keyword(s):

Acute Rejection ◽

Graft Survival ◽

Graft Failure ◽

Patient Survival ◽

Graft Function ◽

Deceased Donor ◽

Delayed Graft Function ◽

Organ Shortage ◽

Increased Risk ◽

Significant Difference

Background: This study aimed to assess the association between the percentage of glomerulosclerosis (GS) in procurement allograft biopsies from high-risk deceased donor and graft outcomes in kidney transplant recipients. Methods: The UNOS database was used to identify deceased-donor kidneys with a kidney donor profile index (KDPI) score > 85% from 2005 to 2014. Deceased donor kidneys were categorized based on the percentage of GS: 0–10%, 11–20%, >20% and no biopsy performed. The outcome included death-censored graft survival, patient survival, rate of delayed graft function, and 1-year acute rejection. Results: Of 22,006 kidneys, 91.2% were biopsied showing 0–10% GS (58.0%), 11–20% GS (13.5%), >20% GS (19.7%); 8.8% were not biopsied. The rate of kidney discard was 48.5%; 33.6% in 0–10% GS, 68.9% in 11–20% GS, and 77.4% in >20% GS. 49.8% of kidneys were discarded in those that were not biopsied. Death-censored graft survival at 5 years was 75.8% for 0–10% GS, 70.9% for >10% GS, and 74.8% for the no biopsy group. Among kidneys with >10% GS, there was no significant difference in death-censored graft survival between 11–20% GS and >20% GS. Recipients with >10% GS had an increased risk of graft failure (HR = 1.27, p < 0.001), compared with 0–10% GS. There was no significant difference in patient survival, acute rejection at 1-year, and delayed graft function between 0% and 10% GS and >10% GS. Conclusion: In >85% KDPI kidneys, our study suggested that discard rates increased with higher percentages of GS, and GS >10% is an independent prognostic factor for graft failure. Due to organ shortage, future studies are needed to identify strategies to use these marginal kidneys safely and improve outcomes.

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