BACKGROUND: We reviewed 843 first cadaver kidney transplants carried out consecutively at our center to examine the effect on long-term graft survival of the duration of delayed graft function (DGF), defined as the time taken for the kidney to attain the threshold of a Cockcroft calculated creatinine clearance (cCCr) > or = 10 ml/min. METHODS: Using a multivariate Cox survival analysis we evaluated the consequences of DGF on allograft survival, and then by regression analysis identified the factors contributing to the occurrence of DGF. Finally, using a Kaplan Meier analysis we compared the profiles of graft failure according to the duration of DGF. RESULTS: Defining DGF in terms of cCCr rather than necessity for dialysis after transplantation allowed better prediction of long-term graft loss. Indeed, patients with a Cockcroft-based DGF > six days who did not require dialysis (12%) had a significantly poorer long-term graft outcome than those with a DGF < or = six days. Furthermore, we showed that a DGF of six days could be taken as a cut-off point that marked a significant difference in the long-term graft survival rate (P < 0.0001). Surprisingly, further extension of the duration of DGF > six days was not associated with further worsening of graft survival (except in DGF > 30 days). CONCLUSION: Our results suggest a threshold effect in the lesions that ultimately results in long-term functional deficiency. In addition, we show that the need for dialysis is not an adequate criterium for DGF in terms of long-term outcome prediction.
BACKGROUND: We reviewed 843 first cadaver kidney transplants carried out consecutively at our center to examine the effect on long-term graft survival of the duration of delayed graft function (DGF), defined as the time taken for the kidney to attain the threshold of a Cockcroft calculated creatinine clearance (cCCr) > or = 10 ml/min. METHODS: Using a multivariate Cox survival analysis we evaluated the consequences of DGF on allograft survival, and then by regression analysis identified the factors contributing to the occurrence of DGF. Finally, using a Kaplan Meier analysis we compared the profiles of graft failure according to the duration of DGF. RESULTS: Defining DGF in terms of cCCr rather than necessity for dialysis after transplantation allowed better prediction of long-term graft loss. Indeed, patients with a Cockcroft-based DGF > six days who did not require dialysis (12%) had a significantly poorer long-term graft outcome than those with a DGF < or = six days. Furthermore, we showed that a DGF of six days could be taken as a cut-off point that marked a significant difference in the long-term graft survival rate (P < 0.0001). Surprisingly, further extension of the duration of DGF > six days was not associated with further worsening of graft survival (except in DGF > 30 days). CONCLUSION: Our results suggest a threshold effect in the lesions that ultimately results in long-term functional deficiency. In addition, we show that the need for dialysis is not an adequate criterium for DGF in terms of long-term outcome prediction.
Authors: Kenneth R Williams; Christopher M Colangelo; Lin Hou; Lisa Chung; Justin M Belcher; Thomas Abbott; Isaac E Hall; Hongyu Zhao; Lloyd G Cantley; Chirag R Parikh Journal: Proteomics Clin Appl Date: 2017-03-31 Impact factor: 3.494
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: Isaac E Hall; Peter P Reese; Mona D Doshi; Francis L Weng; Bernd Schröppel; William S Asch; Joseph Ficek; Heather Thiessen-Philbrook; Chirag R Parikh Journal: Transplantation Date: 2017-08 Impact factor: 4.939
Authors: Isaac E Hall; Sri G Yarlagadda; Steven G Coca; Zhu Wang; Mona Doshi; Prasad Devarajan; Won K Han; Richard J Marcus; Chirag R Parikh Journal: J Am Soc Nephrol Date: 2009-09-17 Impact factor: 10.121