Intraoperative hypotension and prolonged operative time as risk factors for slow graft function in kidney transplant recipients

We analyzed the epidemiologic characteristics and risk factors for surgical site infection (SSI) in kidney transplant recipients. From among 1,939 kidney transplant recipients, 120 with corresponding control subjects were evaluated in this study (1:1 ratio). Reoperation, chronic glomerulonephritis, acute graft rejection, delayed graft function, diabetes, and high body mass index were identified in the analysis as risk factors for SSI.

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Risk factors and outcomes for delayed kidney graft function in simultaneous heart and kidney transplant recipients: A database analysis

American Journal of Transplantation ◽

10.1111/ajt.16535 ◽

2021 ◽

Author(s):

Sandesh Parajuli ◽

Aos.S. Karim ◽

Brenda L. Muth ◽

Glen.E. Leverson ◽

Qiuyu Yang ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Graft Function ◽

Kidney Graft ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Database Analysis

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Risk Factors Associated With Decreasing Graft Function in Kidney Transplant Recipients.

Transplantation Journal ◽

10.1097/00007890-201407151-01584 ◽

2014 ◽

Vol 98 ◽

pp. 475

Author(s):

C. Bucsa ◽

G. Stefan ◽

D. Tacu ◽

C. Baston ◽

M. Harza ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Factors Associated

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P1640COLONIZATION AND INFECTION WITH ESBL-PRODUCING AND CARBAPENEM-RESISTANT ENTEROBACTERIACIEAE IN KIDNEY TRANSPLANT RECIPIENTS: RISK FACTORS, IMPACT OF RENAL GRAFT FUNCTION AND USE OF HOSPITAL RESOURCES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1640 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Alessandra Palmisano ◽

Eleonora Salsi ◽

Paride Fenaroli ◽

Anna Maria Degli Antoni ◽

Ilaria Gandolfini ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Post Transplantation ◽

Renal Graft ◽

Carbapenem Resistant ◽

Hospital Resources

Abstract Background and Aims ESBL-producing and carbapenem resistant (CR) Enterobacteriaceae are a common cause of severe infection, morbidity and mortality in kidney transplant recipients (KTR). Few studies have investigated the risk factors for ESBL-producing/CR Enterobacteriaceae colonization and infection in this group of patients, the effect of colonization and infection on KTR’s renal graft function, and the use of hospital resources. Method Retrospective follow-up study on a consecutive series of patients undergoing kidney transplantation at Parma University Hospital (Italy) between January-2016 and December-2018. We performed a multivariable-adjusted analysis of the predictive factor associated with MDR infection/colonization via general linear models for prevalence- and risk- ratio. Renal function (eGFR) decline was compared by mixed-effects random-coefficients models, hospital resources by negative binomial regression. Results We enrolled 180 KTR (mean recipient’s age: 52.4 [SD 12.4]; males 65%; mean donor’s age: 54.6 [SD 15.6]) and followed them up for 2-years post transplantation. Cumulative prevalence of colonization 3-months post-transplantation and cumulative incidence of infection were 26.1% and 9.4% for ESBL, and 4.4% and 1.6% for CR. ESBL colonization was associated with hemodialysis vs peritoneal dialysis (93% vs 70% non-colonized; adjusted RR 0.21 [95% CI: 0.06 to 0.98]), dialysis vintage (mean months: 65 vs 42; adjusted associated with being above the median, RR 2.17 [95% CI: 1.32 to 3.55]) and retention of ureteral stent for more than one month after transplant (28% vs 12%; adjusted RR 2.09 [95% CI: 1.27 to 3.44]) ; ESBL infection was associated with retention of ureteral stent (47% vs 13%; adjusted RR 4.89 [95% CI 2.11 to 11.35]) whereas CR colonization was associated with surgical complication during transplant admission (50% vs 15%; adjusted RR 4.61 [95% CI 1.28 to 16.66]). Two patients (both with CR) died over the study follow-up, whereas none of the patients lost the graft. CR infection was associated lower baseline (3-months post-transplantation) eGFR compared to the other groups (-28.4mL/min/1.73m2 [95% CI: -50.5 to -6.3]); a numerically more rapid decline (up to - 5mL/min/year) of eGFR, albeit not statistically significant, was observed in patients with CR colonization compared to non-colonized at 2 years of follow-up. In comparison with non-colonized patients, adjusted mean days of carbapenem treatment in ESBL/CR colonized/infected was 5.7 vs 0.7 (P=0.003); length-of-hospital stay 5.8 vs 1.0 (P=0.055); days on drug-resistant-infection intravenous-outpatient-therapy 20.7 vs 0.1 (P= 0.008). Conclusions The study shows that ESBL and CR colonization and infection in KTR are statistically associated with longer hemodialysis vintage, urological procedures, and surgical complications. They cause an increase in the hospital resources use and may jeopardize transplant outcomes.

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Incidence, Risk Factors, and Outcomes of Kidney Transplant Recipients Treated With Both Basiliximab and Antithymocyte Globulin

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120964061 ◽

2020 ◽

Vol 7 ◽

pp. 205435812096406

Author(s):

Rachel Jeong ◽

Robert R. Quinn ◽

Krista L. Lentine ◽

Pietro Ravani ◽

Feng Ye ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Kidney Transplant ◽

Induction Therapy ◽

Graft Failure ◽

Antithymocyte Globulin ◽

Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Incidence Risk

Background: Kidney transplant recipients are given induction therapy to rapidly reduce the immune response and prevent rejection. Guidelines recommend that an interleukin-2 receptor antibody (basiliximab) be the first-line agent and that a lymphocyte-depleting agent (antithymocyte globulin [ATG]) be reserved for those at high immunologic risk. Objective: To determine the incidence, risk factors, and outcomes for patients who receive both basiliximab and ATG for induction compared to either agent alone. Design: Retrospective cohort study. Setting: We used the transplant electronic medical record at the University of Alberta Hospital in Edmonton, Canada. Patients/samples/participants: We included incident adult kidney transplant recipients from 2013 to 2018. Measurements: We measured baseline characteristics, type, and dose of induction therapy used, estimated glomerular filtration rate (eGFR) at 1-year posttransplant, and outcomes of all-cause graft failure, death-censored graft failure, all-cause mortality, and death with a functioning graft. Methods: Differences between induction groups were compared using chi-square test for categorical variables and Kruskal-Wallis tests for continuous variables. We performed multivariable logistic regression modeling with type of induction therapy as the dependent variable and the case-level factors as the predictors (adjusted odds ratio). We estimated the Kaplan-Meier failure functions and used log-rank tests to assess statistical significance of differences in unadjusted incidence across induction therapy types. We compared cumulative incidence functions using a Fine and Gray competing risk regression model. Results: In all, 430 kidney transplant recipients were followed for a mean of 3.9 years (standard deviation 1.5). Of these, 71% (n = 305) received basiliximab alone, 22% (n = 93) received ATG alone, and 7% (n = 32) received both basiliximab and ATG. After adjusting for age and sex, compared to the basiliximab alone group, patients were more likely to receive dual-induction therapy if they were sensitized (calculated panel reactive antibody ≥80%), had diabetes mellitus or peripheral vascular disease, or experienced delayed graft function. Compared to the ATG alone group, the dual-induction therapy group had worse graft function at 1 year (mean eGFR 42 vs. 59 mL/min/1.73 m2, P = .0008) and an increased risk of all-cause graft failure (31% vs. 13%, P = .02) and death-censored graft failure (16% vs. 4%, P = .03). Limitations: There is a risk of confounding by indication, as patients who received dual-induction therapy likely had worse outcomes due to the indication for dual-induction therapy (such as delayed graft function). Conclusions: In our study, 1 out of 10 recipients who were treated with basiliximab also received ATG for induction therapy. These patients experienced worse outcomes than those treated with ATG alone. Trial registration: Not applicable (cohort study).

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Delayed graft function in kidney transplant recipients: risk factors and short-term outcome

Transplantation Proceedings ◽

10.1016/s0041-1345(01)02796-8 ◽

2002 ◽

Vol 34 (1) ◽

pp. 352-354 ◽

Cited By ~ 3

Author(s):

R.A Iglesias-Márquez ◽

E.A Santiago-Delpı́n ◽

E Zayas ◽

Z González-Caraballo ◽

L Morales-Otero

Keyword(s):

Risk Factors ◽

Kidney Transplant ◽

Graft Function ◽

Delayed Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome

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

Journal of Clinical Medicine ◽

10.3390/jcm10122586 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2586

Author(s):

Stephan Kemmner ◽

Christopher Holzmann-Littig ◽

Helene Sandberger ◽

Quirin Bachmann ◽

Flora Haberfellner ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Kidney Transplant ◽

Graft Function ◽

Delayed Graft Function ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Operating Characteristics ◽

Lower Odds ◽

Increased Risk

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.

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Prevalence and risk factors of post-kidney transplant hyperparathyroidism: a single-center study

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2020-2-63-71 ◽

2020 ◽

Vol 22 (2) ◽

pp. 63-71

Author(s):

O. N. Vetchinnikova ◽

M. Yu. Ivanova

Keyword(s):

Risk Factors ◽

Vitamin D ◽

Kidney Transplant ◽

Graft Function ◽

Transplant Recipients ◽

Single Center ◽

Kidney Transplant Recipients ◽

Post Transplant ◽

Group 2 ◽

Group 1

Objective: to assess the prevalence of hyperparathyroidism (HPT) and the factors affecting its development in kidney transplant recipients. Materials and methods. The single-center observational cohort study included 97 kidney transplant recipients – 40 men, 57 women, age 50 ± 9 years. Inclusion criteria: more than 12 months of post-transplant period, 3 months of stable renal transplant function. Non-inclusion criterion: therapy with vitamin D, with its alternatives or with cinacalcet. Dialysis ranged from 0 to 132 months (median 18); 46% of patients had pre-operative secondary HPT. A comprehensive laboratory study included evaluation of serum concentrations of parathyroid hormone (PTH), 25-OH vitamin D, calcium, phosphorus, magnesium, total alkaline phosphatase (ALP) activity, albumin, creatinine and daily proteinuria. At the dialysis stage, the target PTH range of 130–585 pg/ ml was used, in the post-transplant period – ≤130 pg/ml. Glomerular filtration rate (eGFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula. Results. Patients were divided into two groups based on PTH threshold level (130 pg/ml): the first with HPT (PTH >130 pg/ml, median 203), the second without HPT (PTH ≤130 pg/ml, median 101). Both groups were comparable in terms of gender, age, primary renal disease, dialysis modality, post-transplant follow-up, and immunosuppressive therapy regimen. In group 1 and group 2 recipients, dialysis therapy, pre-transplant median PTH level, incidence of reoperation and incidence of immediate renal graft function were 30 (14; 50) and 14 (6; 28) months (p = 0.004), 681 (538; 858) and 310 (182; 556) pg/ml (p < 0.001), 17% and 2% (p = 0.028), 51% and 80% (p = 0.005), respectively. At the time of the study, 72% of group 1 recipients had eGFR <60 ml/min, versus 36% of group 2 (p >< 0.001). Among HPT biochemical parameters, there were differences for ionized serum calcium (1.32 ± 0.07 versus 1.29 ± 0.04 mmol/l, p = 0.017) and ALP activity (113 ± 61 versus 75 ± 19 u/l, p = 0.021). Serum vitamin D in both groups reduced in equal measures – 14 ± 4 and 15 ± 6 ng/ml. Conclusion. Persistent HPT in the long-term post-transplant period reaches 48.5%. Risk factors for its development included dialysis for more than 18 months, pre-operative secondary HPT, repeated kidney transplantation, delayed graft function, and eGFR <60 ml/min.

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