Cargando…

Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes

Delayed graft function (DGF) after kidney transplantation is associated with higher rates of acute rejection and poor graft survival and outcomes. Current DGF definitions based on posttransplant need for dialysis are not standardized and there are no objective methodologies for quantifying DGF sever...

Descripción completa

Detalles Bibliográficos
Autores principales: Kurian, Sunil M., Stewart, Darren E., Toll, Alice, Checchi, Kyle, Case, Jamie, Marsh, Christopher L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671751/
https://www.ncbi.nlm.nih.gov/pubmed/36406898
http://dx.doi.org/10.1097/TXD.0000000000001414
_version_ 1784832615802470400
author Kurian, Sunil M.
Stewart, Darren E.
Toll, Alice
Checchi, Kyle
Case, Jamie
Marsh, Christopher L.
author_facet Kurian, Sunil M.
Stewart, Darren E.
Toll, Alice
Checchi, Kyle
Case, Jamie
Marsh, Christopher L.
author_sort Kurian, Sunil M.
collection PubMed
description Delayed graft function (DGF) after kidney transplantation is associated with higher rates of acute rejection and poor graft survival and outcomes. Current DGF definitions based on posttransplant need for dialysis are not standardized and there are no objective methodologies for quantifying DGF severity. METHODS: Using Organ Procurement and Transplantation Network data, we examined DGF, and used recipient serum creatinine at discharge as a correlate of renal function and DGF severity (mild: <2.5 mg/dL; severe: ≥2.5 mg/dL). The associations between donor and recipient factors and DGF severity were quantified using logistic regression. We also examined the associations between DGF severity and long-term recipient outcomes, adjusting for potential confounders. RESULTS: A predictive model using donor and recipient factors had a reasonably good ability to discriminate mild (low creatinine) versus severe (high creatinine) DGF (c-statistic of 0.70). In Cox regression, DGF and creatinine at discharge were both independently associated with long-term outcomes, yet their effects differed depending on the outcome (graft function, death-censored graft function, recipient mortality). Our findings suggest that having DGF, but with relatively good renal function (creatinine <2.5) at discharge, may be less deleterious on graft and recipient survival compared with severe, prolonged DGF, which was associated with a decreased median graft survival of ~2.6 y compared with no DGF with low creatinine at discharge. CONCLUSIONS. Our novel DGF severity stratification identified unique factors associated with DGF severity, along with DGF’s association with long-term graft and patient survival. The adverse cost and outcome implications of severe DGF warrant additional investigation to improve kidney transplantation practice.
format Online
Article
Text
id pubmed-9671751
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-96717512022-11-18 Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes Kurian, Sunil M. Stewart, Darren E. Toll, Alice Checchi, Kyle Case, Jamie Marsh, Christopher L. Transplant Direct Kidney Transplantation Delayed graft function (DGF) after kidney transplantation is associated with higher rates of acute rejection and poor graft survival and outcomes. Current DGF definitions based on posttransplant need for dialysis are not standardized and there are no objective methodologies for quantifying DGF severity. METHODS: Using Organ Procurement and Transplantation Network data, we examined DGF, and used recipient serum creatinine at discharge as a correlate of renal function and DGF severity (mild: <2.5 mg/dL; severe: ≥2.5 mg/dL). The associations between donor and recipient factors and DGF severity were quantified using logistic regression. We also examined the associations between DGF severity and long-term recipient outcomes, adjusting for potential confounders. RESULTS: A predictive model using donor and recipient factors had a reasonably good ability to discriminate mild (low creatinine) versus severe (high creatinine) DGF (c-statistic of 0.70). In Cox regression, DGF and creatinine at discharge were both independently associated with long-term outcomes, yet their effects differed depending on the outcome (graft function, death-censored graft function, recipient mortality). Our findings suggest that having DGF, but with relatively good renal function (creatinine <2.5) at discharge, may be less deleterious on graft and recipient survival compared with severe, prolonged DGF, which was associated with a decreased median graft survival of ~2.6 y compared with no DGF with low creatinine at discharge. CONCLUSIONS. Our novel DGF severity stratification identified unique factors associated with DGF severity, along with DGF’s association with long-term graft and patient survival. The adverse cost and outcome implications of severe DGF warrant additional investigation to improve kidney transplantation practice. Lippincott Williams & Wilkins 2022-11-17 /pmc/articles/PMC9671751/ /pubmed/36406898 http://dx.doi.org/10.1097/TXD.0000000000001414 Text en Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Kidney Transplantation
Kurian, Sunil M.
Stewart, Darren E.
Toll, Alice
Checchi, Kyle
Case, Jamie
Marsh, Christopher L.
Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes
title Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes
title_full Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes
title_fullStr Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes
title_full_unstemmed Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes
title_short Renal Function at Discharge Among Kidney Recipients Experiencing Delayed Graft Function and Its Associations With Long-term Outcomes
title_sort renal function at discharge among kidney recipients experiencing delayed graft function and its associations with long-term outcomes
topic Kidney Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671751/
https://www.ncbi.nlm.nih.gov/pubmed/36406898
http://dx.doi.org/10.1097/TXD.0000000000001414
work_keys_str_mv AT kuriansunilm renalfunctionatdischargeamongkidneyrecipientsexperiencingdelayedgraftfunctionanditsassociationswithlongtermoutcomes
AT stewartdarrene renalfunctionatdischargeamongkidneyrecipientsexperiencingdelayedgraftfunctionanditsassociationswithlongtermoutcomes
AT tollalice renalfunctionatdischargeamongkidneyrecipientsexperiencingdelayedgraftfunctionanditsassociationswithlongtermoutcomes
AT checchikyle renalfunctionatdischargeamongkidneyrecipientsexperiencingdelayedgraftfunctionanditsassociationswithlongtermoutcomes
AT casejamie renalfunctionatdischargeamongkidneyrecipientsexperiencingdelayedgraftfunctionanditsassociationswithlongtermoutcomes
AT marshchristopherl renalfunctionatdischargeamongkidneyrecipientsexperiencingdelayedgraftfunctionanditsassociationswithlongtermoutcomes