Limits...
Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome.

Chaumont M, Racapé J, Broeders N, El Mountahi F, Massart A, Baudoux T, Hougardy JM, Mikhalsky D, Hamade A, Le Moine A, Abramowicz D, Vereerstraeten P - J Transplant (2015)

Bottom Line: DGF does not influence patient survival (P = 0.54).However, graft survival is decreased only when rejection was associated with DGF (P < 0.001).  Conclusions.DGF per se has no influence on patient and graft outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium.

ABSTRACT
Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient's perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2-2.9]). Moreover, we observed two novel risk factors for DGF: patient's residual diuresis ≤500 mL/d (OR = 2.3 [1.6-3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0-5.4]). Area under the curve of the ROC curve (0.77 [0.74-0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival (P = 0.54). However, graft survival is decreased only when rejection was associated with DGF (P < 0.001).  Conclusions. Perioperative saline loading efficiently prevents ischemia-reperfusion injury, which is the predominant factor inducing DGF. DGF per se has no influence on patient and graft outcome. Its incidence is currently close to 5% in our centre.

No MeSH data available.


Related in: MedlinePlus

Deceased censored graft survival according to presence (+) or absence (−) of delayed graft function (DGF) and acute rejection episodes (ARE) in 1784 grafts performed from 1983 to 2014.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4581567&req=5

fig2: Deceased censored graft survival according to presence (+) or absence (−) of delayed graft function (DGF) and acute rejection episodes (ARE) in 1784 grafts performed from 1983 to 2014.

Mentions: Survival was studied in three groups according to presence (+) or absence (−) of DGF and ARE: group 1 DGF−/ARE− (n = 1402), group 2 DGF+/ARE− (n = 300), and group 3 DGF+/ARE+ (n = 82). Patient survival was similar in the three groups: at ten years it was 84.5% in group 1, 86.8% in group 2, and 86.5% in group 3 (P = 0.54). On the contrary, whereas no difference in deceased censored graft survival was observed between groups 1 and 2 (P = 0.45), survival was much lower (P < 0.001) in group 3 than in the other two groups (Figure 2), most of this difference being reached during the first year. Multivariate Cox analysis including all risk factors for deceased censored graft survival (see Patients and Methods) yielded similar results (not shown).


Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome.

Chaumont M, Racapé J, Broeders N, El Mountahi F, Massart A, Baudoux T, Hougardy JM, Mikhalsky D, Hamade A, Le Moine A, Abramowicz D, Vereerstraeten P - J Transplant (2015)

Deceased censored graft survival according to presence (+) or absence (−) of delayed graft function (DGF) and acute rejection episodes (ARE) in 1784 grafts performed from 1983 to 2014.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4581567&req=5

fig2: Deceased censored graft survival according to presence (+) or absence (−) of delayed graft function (DGF) and acute rejection episodes (ARE) in 1784 grafts performed from 1983 to 2014.
Mentions: Survival was studied in three groups according to presence (+) or absence (−) of DGF and ARE: group 1 DGF−/ARE− (n = 1402), group 2 DGF+/ARE− (n = 300), and group 3 DGF+/ARE+ (n = 82). Patient survival was similar in the three groups: at ten years it was 84.5% in group 1, 86.8% in group 2, and 86.5% in group 3 (P = 0.54). On the contrary, whereas no difference in deceased censored graft survival was observed between groups 1 and 2 (P = 0.45), survival was much lower (P < 0.001) in group 3 than in the other two groups (Figure 2), most of this difference being reached during the first year. Multivariate Cox analysis including all risk factors for deceased censored graft survival (see Patients and Methods) yielded similar results (not shown).

Bottom Line: DGF does not influence patient survival (P = 0.54).However, graft survival is decreased only when rejection was associated with DGF (P < 0.001).  Conclusions.DGF per se has no influence on patient and graft outcome.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, Belgium.

ABSTRACT
Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient's perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2-2.9]). Moreover, we observed two novel risk factors for DGF: patient's residual diuresis ≤500 mL/d (OR = 2.3 [1.6-3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0-5.4]). Area under the curve of the ROC curve (0.77 [0.74-0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival (P = 0.54). However, graft survival is decreased only when rejection was associated with DGF (P < 0.001).  Conclusions. Perioperative saline loading efficiently prevents ischemia-reperfusion injury, which is the predominant factor inducing DGF. DGF per se has no influence on patient and graft outcome. Its incidence is currently close to 5% in our centre.

No MeSH data available.


Related in: MedlinePlus