BACKGROUND: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. METHODS: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. RESULTS: Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34). CONCLUSIONS: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.
BACKGROUND: Delayed graft function (DGF) complicates kidney allograft outcomes in the immediate post-transplantation period. We hypothesized that in hemodialysis patients more severe anemia, iron deficiency, the requirement for higher doses of erythropoietin-stimulating agents (ESA), or blood transfusions prior to transplantation are associated with higher risk of DGF. METHODS: Linking five-yr hemodialysis patient data of a large dialysis organization to the Scientific Registry of Transplant Recipients, we identified 11 836 hemodialysis patients. Using logistic regression analyses we examined the association between pre-transplant parameters and post-transplant DGF. RESULTS:Patients were 49 ± 14 (mean ± SD) yr old and included 38% women, 27% blacks, and 26% diabetics. After adjusting for relevant covariates, pre-transplant blood transfusion was associated with 33% higher DGF risk (odds ratio [OR] = 1.33; 95% confidence interval [CI]: 1.19-1.48); and each 5000 U/wk increase of pre-transplant ESA dose with 5% higher DGF (OR = 1.05; 95% CI: 1.02-1.09). Compared to pre-transplant blood hemoglobin of 12-12.99 g/dL, there was 25% higher risk of DGF with blood hemoglobin 10-10.99 g/dL (OR = 1.25; 95% CI: 1.01-1.55), whereas blood hemoglobin ≥13 g/dL exhibited 15% higher risk of DGF (OR = 1.15; 95% CI: 0.98-1.34). CONCLUSIONS: Pre-transplant blood transfusion, higher ESA dose, and either high or low blood hemoglobin but not iron markers are associated with higher risk of DGF.
Authors: M A Gentil; M P Alcaide; G R Algarra; P Pereira; J Toro; F González-Roncero; M López; G Bernal; J Mateos Journal: Transplant Proc Date: 2003-03 Impact factor: 1.066
Authors: Sri G Yarlagadda; Steven G Coca; Amit X Garg; Mona Doshi; Emilio Poggio; Richard J Marcus; Chirag R Parikh Journal: Nephrol Dial Transplant Date: 2008-04-11 Impact factor: 5.992
Authors: Kamyar Kalantar-Zadeh; Ryan D Kilpatrick; Noriko Kuwae; Charles J McAllister; Harry Alcorn; Joel D Kopple; Sander Greenland Journal: Nephrol Dial Transplant Date: 2005-06-14 Impact factor: 5.992
Authors: I J Dawidson; Z F Sandor; L Coorpender; B Palmer; P Peters; C Lu; A Sagalowsky; R Risser; C Willms Journal: Transplantation Date: 1992-04 Impact factor: 4.939
Authors: Christian S Shinaberger; Sander Greenland; Joel D Kopple; David Van Wyck; Rajnish Mehrotra; Csaba P Kovesdy; Kamyar Kalantar-Zadeh Journal: Am J Clin Nutr Date: 2008-12 Impact factor: 7.045