scholarly journals RELATIONSHIP BETWEEN WARM ISCHEMIC TIME AND RESISTIVE INDEX ON CREATININ REDUCTION RATIO DAY TWO AFTER LIVING KIDNEY DONOR TRANSPLANTATION

2021 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
Lusito ◽  
Ayudyah Nurani ◽  
Dwi Lestari Partiningrum ◽  
Arwedi Arwanto ◽  
Lestariningsih ◽  
...  
Keyword(s):  
Multiple Logistic Regression Analysis ◽  
Graft Function ◽  
Resistive Index ◽  
Reduction Ratio ◽  
Delayed Graft Function ◽  
Kidney Donor ◽  
Living Kidney Donor ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Hormonal Function

Kidney transplantation (KT) may improve kidney function, via filtration, excretion, and hormonal function better than other kidney replacement therapies. Many factors may cause graft rejection or delayed graft function which may decrease the prognosis for graft survival. This study aims to determine associated factors of serum creatinine reduction ratio day 2 (CRR2) after living kidney donor transplants. This research used a retrospective cohort study design, with total sampling based on complete documents was done. A total 44 respondents (from 2012 to January 2020) and 22 respondents (based on the complete Resistive Index (RI) were recorded since 2018). Early Graft Function was defined using CRR2. Immediate Graft Function (IGF) was defined if CRR2 > 30% and Delayed Graft Function (DGF) if CRR2 ≤ 30%. The results of Multiple logistic regression analysis from 44 samples showed that Warm Ischemic Time (WIT) ≤ 40 minutes was significantly associated with IGF (OR 10.78; 95%CI: 1.66 to 70.16; p=0.01). A result with 22 samples showed that, only RI ≤ 0.7was significantly associated with IGF (OR 0.11; 95%CI: 0.03-0.41; p=0.002). In conclusion, WIT and RI influence on EGF with parameters CRR2 of living-donors. KT Patients with WIT ≤40 minutes and RI ≤0.7 had a higher risk of IGF.

Delayed graft function and perfusion parameters of kidneys from uncontrolled donors after circulatory death

Perfusion ◽  
2020 ◽  
pp. 026765912093892
Author(s):  
Adriano Peris ◽  
Giorgio Enzo Fulceri ◽  
Chiara Lazzeri ◽  
Manuela Bonizzoli ◽  
Vincenzo Li Marzi ◽  
...  
Keyword(s):  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Machine Perfusion ◽  
Hemodynamic Parameters ◽  
Ischemic Time ◽  
Warm Ischemic Time ◽  
Hypothermic Machine Perfusion ◽  
Circulatory Death

Better preservation and evaluation of kidneys from donors after circulatory death serve to increase the number of kidneys available for transplantation and hypothermic machine perfusion has been shown to decrease ischemia reperfusion injury and delayed graft function. Data on relation between hemodynamic parameters during hypothermic machine perfusion and delayed graft function in kidneys from donors after circulatory death are so far scarce and not univocal. We aimed at assessing whether hemodynamic parameters measured during hypothermic machine perfusion (flow, mean perfusion pressure, and renal resistance) are associated with delayed graft function in 26 kidneys retrieved from uncontrolled donors after circulatory death. In our series, the incidence of delayed graft function was 57.7% (15/26). Recipients who developed delayed graft function had a longer warm ischemic time (p = 0.04). All hemodynamic parameters measured during hypothermic machine perfusion were comparable between recipients with delayed graft function and those without. According to our data, in kidneys from uncontrolled donors after circulatory death, a longer warm ischemic time (that is the overall time of no flow, as the sum of the no-flow and the no-touch period) is associated with delayed graft function. This finding underscores the pivotal role of ischemic injury in terms of absence of flow in affecting graft function. No association was detectable between hemodynamic parameters during hypothermic machine perfusion and the development of delayed graft function in our series.

scholarly journals Kidney transplant outcomes after medical assistance in dying

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Patrick P. Luke ◽  
Anton Skaro ◽  
Alp Sener ◽  
Ephraim Tang ◽  
Max Levine ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Large Scale ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Medical Assistance ◽  
Ischemic Time ◽  
Transplant Outcomes ◽  
Medical Assistance In Dying ◽  
Cold Ischemic Time ◽  
The Mean

Introduction: After nearly four years of Canadian experience with medical assistance in dying (MAiD), the clinical volume of organ transplantation following MAiD remains low. This is the first Canadian report evaluating recipient outcomes from kidney transplantation following MAiD. Methods: This was a retrospective review of the first nine cases of kidney transplants following MAiD at a Canadian transplant center. Results: Nine patients underwent MAiD followed by kidney retrieval during the study period. Their diagnoses were largely neuromuscular diseases. The mean warm ischemic time was 20 minutes (standard deviation [SD] 7). The nine recipients had a mean age of 60 (SD 19.7). The mean cold ischemic time was 525 minutes (SD 126). Delayed graft function occurred in only one patient out of nine. The mean 30-day creatinine was 124 umol/L (SD 52) . The mean three-month creatinine was 115 umol/L (SD 29). Conclusions: We report nine cases of kidney transplantation following MAiD. The process minimized warm ischemia, resulting in low delayed graft function rates, and acceptable post-transplant outcomes. Further large-scale research is necessary to optimize processes and outcomes in this novel clinical pathway.

scholarly journals Quantifying Donor Effects on Transplant Outcomes Using Kidney Pairs from Deceased Donors

2019 ◽  
Vol 14 (12) ◽  
pp. 1781-1787
Author(s):  
Kathleen F. Kerr ◽  
Eric R. Morenz ◽  
Heather Thiessen-Philbrook ◽  
Steven G. Coca ◽  
F. Perry Wilson ◽  
...  
Keyword(s):  
Relative Risk ◽  
Clinical Outcomes ◽  
Graft Failure ◽  
Absolute Risk ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Kidney Donor ◽  
Excess Absolute Risk ◽  
Deceased Donors ◽  
Concordance Measures

Background and objectivesIn kidney transplantation, the relative contribution of donor versus other factors on clinical outcomes is unknown. We sought to quantify overall donor effects on transplant outcomes for kidney donations from deceased donors.Design, setting, participants, & measurementsFor paired donations from deceased donors resulting in transplants to different recipients, the magnitude of donor effects can be quantified by examining the excess of concordant outcomes within kidney pairs beyond chance concordance. Using data from the Organ Procurement and Transplantation Network between the years 2013 and 2017, we examined concordance measures for delayed graft function, death-censored 1-year graft failure, and death-censored 3-year graft failure. The concordance measures were excess relative risk, excess absolute risk, and the fixation index (where zero is no concordance and one is perfect concordance). We further examined concordance in strata of kidneys with similar values of the Kidney Donor Profile Index, a common metric of organ quality.ResultsIf the transplant of the kidney mate resulted in delayed graft function, risk for delayed graft function was 19% higher (95% confidence interval [95% CI], 18% to 20%), or 1.76-fold higher (95% CI, 1.73- to 1.80-fold), than baseline. If a kidney graft failed within 1 year, then the kidney mate’s risk of failure was 6% higher (95% CI, 4% to 9%), or 2.85-fold higher (95% CI, 2.25- to 3.48-fold), than baseline. For 3-year graft failure, the excess absolute risk was 7% (95% CI, 4% to 10%) but excess relative risk was smaller, 1.91-fold (95% CI, 1.56- to 2.28-fold). Fixation indices were 0.25 for delayed graft function (95% CI, 0.24 to 0.27), 0.07 for 1-year graft failure (95% CI, 0.04 to 0.09), and 0.07 for 3-year graft failure (95% CI, 0.04 to 0.10). Results were similar in strata of kidneys with a similar Kidney Donor Profile Index.ConclusionsOverall results indicated that the donor constitution has small or moderate effect on post-transplant clinical outcomes.

scholarly journals Creatinine Reduction Ratio on Post-Transplant Day Two as Criterion in Defining Delayed Graft Function

2004 ◽  
Vol 4 (7) ◽  
pp. 1163-1169 ◽  
Author(s):  
Emilio Rodrigo ◽  
Juan C. Ruiz ◽  
Celestino Pinera ◽  
Gema Fernandez-Fresnedo ◽  
Rafael Escallada ◽  
...  
Keyword(s):  
Graft Function ◽  
Reduction Ratio ◽  
Delayed Graft Function ◽  
Post Transplant

scholarly journals Artificial Intelligence—A Tool for Risk Assessment of Delayed-Graft Function in Kidney Transplant

2021 ◽  
Vol 10 (22) ◽  
pp. 5244
Author(s):  
Andrzej Konieczny ◽  
Jakub Stojanowski ◽  
Klaudia Rydzyńska ◽  
Mariusz Kusztal ◽  
Magdalena Krajewska
Keyword(s):  
Machine Learning ◽  
Risk Assessment ◽  
Kidney Transplant ◽  
Graft Function ◽  
Deceased Donor ◽  
Delayed Graft Function ◽  
Clinical Tool ◽  
Kidney Donor ◽  
Common Input ◽  
Discriminant Ability

Delayed-graft function (DGF) might be responsible for shorter graft survival. Therefore, a clinical tool predicting its occurrence is vital for the risk assessment of transplant outcomes. In a single-center study, we conducted data mining and machine learning experiments, resulting in DGF predictive models based on random forest classifiers (RF) and an artificial neural network called multi-layer perceptron (MLP). All designed models had four common input parameters, determining the best accuracy and discriminant ability: donor’s eGFR, recipient’s BMI, donor’s BMI, and recipient–donor weight difference. RF and MLP designs, using these parameters, achieved an accuracy of 84.38% and an area under curve (AUC) 0.84. The model additionally implementing a donor’s age, gender, and Kidney Donor Profile Index (KDPI) accomplished an accuracy of 93.75% and an AUC of 0.91. The other configuration with the estimated post-transplant survival (EPTS) and the kidney donor risk profile (KDRI) achieved an accuracy of 93.75% and an AUC of 0.92. Using machine learning, we were able to assess the risk of DGF in recipients after kidney transplant from a deceased donor. Our solution is scalable and can be improved during subsequent transplants. Based on the new data, the models can achieve better outcomes.

scholarly journals Donor Age, Cold Ischemia Time, and Delayed Graft Function

2020 ◽  
Vol 15 (6) ◽  
pp. 813-821 ◽  
Author(s):  
Ilkka Helanterä ◽  
Hassan N. Ibrahim ◽  
Marko Lempinen ◽  
Patrik Finne
Keyword(s):  
Graft Function ◽  
The United States ◽  
Delayed Graft Function ◽  
Cold Ischemia Time ◽  
Donation After Circulatory Death ◽  
Donor Age ◽  
Cold Ischemia ◽  
Kidney Donor ◽  
Ischemia Time ◽  
Circulatory Death

Background and objectivesIncreased donor age is one of the most important risk factors for delayed graft function (DGF), and previous studies suggest that the harmful effect of cold ischemia time is increased in kidneys from older donors. Our aim was to study the association of increased donor age and cold ischemia time with the risk of delayed graft function in a large cohort kidney transplants from the current era.Design, setting, participants, & measurementsThe Scientific Registry of Transplant Recipients was used for this observational, retrospective registry analysis to identify all deceased donor kidney transplantations in the United States between 2010 and September 2018, who were on dialysis pretransplantation (n=90,810). The association of donor age and cold ischemia time with the risk of DGF was analyzed in multivariable models adjusted for recipient characteristics (age, race, sex, diabetes, calculated panel-reactive antibodies, pretransplant dialysis duration) and donor characteristics (cause of death, sex, race, body mass index, creatinine, donation after circulatory death status, history of hypertension, and HLA mismatch).ResultsCold ischemia time and donor age were independently associated with the risk of DGF, but the risk of DGF was not statistically significantly lower in donor age categories between 50 and 64 years, compared with donors ≥65 years. The harmful association of cold ischemia time was not higher in kidneys from older donors in any age category, not even among donation after circulatory death donors. When donor risk was assessed with kidney donor profile index, although a statistically significant interaction with cold ischemia time was found, no practically meaningful increase in cold-ischemia susceptibility of kidneys with a high kidney donor profile index was found.ConclusionsWe were unable to demonstrate an association between donor age and DGF. The association of longer cold ischemia time with the risk of DGF was not magnified in older or more marginal donors.

Machine Perfusion Decreases Delayed Graft Function in Donor Grafts With High Kidney Donor Profile Index

2020 ◽  
Author(s):  
Martin I. Montenovo ◽  
James D. Perkins ◽  
Catherine E. Kling ◽  
Lena Sibulesky ◽  
Andre A. Dick ◽  
...  
Keyword(s):  
Graft Function ◽  
Delayed Graft Function ◽  
Machine Perfusion ◽  
Kidney Donor

scholarly journals Assessment of risk factors for hospital readmission after kidney transplantation

2021 ◽  
Author(s):  
Mahmoud Tavakkoli ◽  
Amir Yarahmadi ◽  
Mahin Ghorban Sabbagh ◽  
Mona Najaf Najafi ◽  
Milad Tavakoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Transplantation ◽  
Hospital Readmission ◽  
Intraoperative Complications ◽  
Demographic Data ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Post Discharge ◽  
Ischemic Time ◽  
Cold Ischemic Time

Background and Purpose: Hospital readmission after kidney transplantation is a real challenge for both patients and healthcare systems. Assessment of the risk factors of readmission after kidney transplantation is vital and can reduce morbidity and cost in transplant recipients and donors. The aim of the current study was to determine the risk factors of hospital readmission in patients undergoing kidney transplantation in Montaserieh Hospital of Mashhad, northeast of Iran. Materials and Methods: This retrospective study included 523 first kidney transplant patients between January 2013 and March 2019 from the Montaserieh Hospital Information System (HIS) of Mashhad, Iran. Every-time readmission was the study primary outcome. Donors and recipient's demographic data, recipient's comorbidities, reasons for end-stage renal disease (ESRD), panel reactive antibody (PRA) status, dialysis parameters, cold ischemic time, and delayed graft function (DGF) were the potential risk factors. Statistical analysis was done using Chi-square and Student's t-test. Results: Data from 523 patients were assessed for potential eligibility. Based on the exclusion criteria, data from 479 patients were included in the final analysis. 174 (36.3%) patients were never readmitted, and 305 (63.7%) were readmitted at least once post-discharge. 39 (12.8%) were readmitted within the first-month post-discharge. Older age, sex, higher prevalence of comorbidities, diabetes and hypertension, duration of primary disease before transplantation, hemodialysis and duration of pre-transplant dialysis, mean pre-transplant platelet count, intraoperative complications, increased cold ischemic time, and delayed graft function were associated with a higher prevalence of readmission (p<0.05). Conclusion Our results showed that different independent variables and patients' comorbidities were important risk factors for readmission after kidney transplantation. Early prediction of these risk factors could result in prevention from readmission in patients undergoing kidney transplantation.

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