Qipeng Sun1, Zhengyu Huang1, Honglan Zhou2, Minzhuan Lin3, Xuefeng Hua1, Liangqing Hong1, Ning Na1, Ruiming Cai3, Gang Wang2, Qiquan Sun1. 1. Department of Renal Transplantation, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 2. Department of Urology, The First Affiliated Hospital, Jilin University, Changchun, China. 3. Department of Renal Transplantation, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
Abstract
BACKGROUND/AIMS: Delayed graft function (DGF) is a common complication following kidney transplantation adversely affecting graft outcomes. Donation after brain death followed by circulatory death (DBCD), a novel donation pattern, is expected to correlate with high incidence of DGF. However, little information is available about factors associated with DGF in DBCD. METHODS: A total of 383 kidney transplants from DBCD donation in three institutions were enrolled. Associations of DGF with the clinical characteristics of recipients and donors were quantified. RESULTS: In this retrospective multi-center study, the incidence of DGF was 19.3%. Lower incidence of DGF was found in recipients for whom antithymocyte globulin was used for induction (p < 0.05), which was an independent protective factor against DGF (odds ratio [OR] = 0.48; 95% CI 0.27-0.86). Two novel explicative variables were recognized as independent risk factors, including use of vasoactive drugs (OR = 3.15; 95% CI 1.39-7.14) and cardiopulmonary resuscitation (OR = 2.51; 95% CI 1.05-6.00), which contributed significantly to increased risk of DGF (p < 0.05). Prolonged warm ischemia time (> 18 min; OR = 2.42; 95% CI 1.36-4.32), was also predictive of DGF in DBCD. A prediction model was developed and achieved an area under the curve of 0.89 in predicting DGF when combined with reported parameters. CONCLUSION: The novel factors, confirmed for the first time in our study, will help to improve risk prediction of DGF and to determine optimal interventions to prevent DGF in clinical practice.
BACKGROUND/AIMS: Delayed graft function (DGF) is a common complication following kidney transplantation adversely affecting graft outcomes. Donation after brain death followed by circulatory death (DBCD), a novel donation pattern, is expected to correlate with high incidence of DGF. However, little information is available about factors associated with DGF in DBCD. METHODS: A total of 383 kidney transplants from DBCD donation in three institutions were enrolled. Associations of DGF with the clinical characteristics of recipients and donors were quantified. RESULTS: In this retrospective multi-center study, the incidence of DGF was 19.3%. Lower incidence of DGF was found in recipients for whom antithymocyte globulin was used for induction (p < 0.05), which was an independent protective factor against DGF (odds ratio [OR] = 0.48; 95% CI 0.27-0.86). Two novel explicative variables were recognized as independent risk factors, including use of vasoactive drugs (OR = 3.15; 95% CI 1.39-7.14) and cardiopulmonary resuscitation (OR = 2.51; 95% CI 1.05-6.00), which contributed significantly to increased risk of DGF (p < 0.05). Prolonged warm ischemia time (> 18 min; OR = 2.42; 95% CI 1.36-4.32), was also predictive of DGF in DBCD. A prediction model was developed and achieved an area under the curve of 0.89 in predicting DGF when combined with reported parameters. CONCLUSION: The novel factors, confirmed for the first time in our study, will help to improve risk prediction of DGF and to determine optimal interventions to prevent DGF in clinical practice.
Authors: Elizabeth A Swanson; Madhukar S Patel; Tahnee Groat; Nora E Jameson; Margaret K M Ellis; Michael P Hutchens; Claus U Niemann; Darren J Malinoski; Mitchell B Sally Journal: J Trauma Acute Care Surg Date: 2020-06 Impact factor: 3.697
Authors: Silvana Daher Costa; Luis Gustavo Modelli de Andrade; Francisco Victor Carvalho Barroso; Cláudia Maria Costa de Oliveira; Elizabeth De Francesco Daher; Paula Frassinetti Castelo Branco Camurça Fernandes; Ronaldo de Matos Esmeraldo; Tainá Veras de Sandes-Freitas Journal: PLoS One Date: 2020-02-06 Impact factor: 3.240