Delayed graft function: Risk factors, consequences and parameters affecting outcome—results from MOST, A Multinational Observational Study

doi:10.1016/j.transproceed.2004.12.297

Transplantation Proceedings

Volume 37, Issue 1, January–February 2005, Pages 345-347

https://doi.org/10.1016/j.transproceed.2004.12.297 Get rights and content

Abstract

Background

Delayed graft function (DGF) is a common complication after renal transplantation, and may affect graft function. The aim of this analysis was to evaluate risk factors for DGF, as well as parameters and events influencing graft function after DGF. We analyzed data collected in an ongoing international, prospective; observational study, the Neoral-MOST (Multinational Observational Study in renal Transplantation), and included in the analysis all patients with cadaveric kidney transplants for whom renal function at 1 year posttransplantation was documented (N = 8950). Logistic regression was used to evaluate the risk factors for DGF occurrence, and multifactorial analysis of variance (ANCOVA) to assess the relevance of different factors for GFR at 1 year.

Results

Higher donor age, longer CIT, male recipients, Caucasian recipients, high recipients body mass index, and PRA were all associated with a higher risk for DGF. Renal function of former DGF kidneys at 1 year was lower in kidneys of elder donors, or which had experienced rejection or CMV infection. Variations of the maintenance regimen at 1 year posttransplantation were not associated with better graft function. Multifactorial analysis showed donor age and acute rejection as significant independent factors.

Conclusions

Most factors increasing the risk for DGF or having a negative impact on renal function at 1 year in grafts with DGF are predetermined. Additional posttransplant damage by acute rejection was associated with further reductions in GFR. Preventing acute rejection is an important step in achieving optimal function of DGF grafts.

Section snippets

Study design

The Neoral-MOST study is an international, prospective, observational ongoing study set up to investigate the use and impact of different immunosuppressive regimens in combination with Neoral (cyclosporine microemulsion, Novartis, Basel) on clinical outcomes after solid organ transplantation. It involves 185 transplant units (155 renal, 26 liver, 4 both) from 38 countries located in Europe, Asia-Pacific, Latin America, Canada, and Australia. To qualify for enrolment, patients need to have

Results

At the time of analysis, 8950 patients who had received a cadaveric graft provided sufficient information to contribute to the analyses on 1-year GFR. Among these, 2028 (22.7%) had DGF and 6922, IGF.

Discussion

This analysis of a global transplant population confirmed donor age and CIT as highly significant risk factors for DGF, as published recently by Irish et al based on US data.² In addition, recipient obesity had a significant influence on DGF incidence. In our global, non-US data set with very few black recipients, Caucasian race was a risk factor and was associated with a higher DGF incidence compared to the other races (mainly oriental), even when we corrected for regions. Not unexpectedly,

Acknowledgments

The data have been collected by 159 renal transplantation centers participating in the Neoral®-MOST Study. The statistical analyses were performed by Oxford Pharmaceutical Sciences, UK.

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One-year posttransplant renal function is a strong predictor of long-term kidney function: results from the Neoral-MOST Observational Study
Transplant Proc
(2003)
S. Hariharan et al.
Post-transplant renal function in the first year predicts long-term kidney transplant survival
Kidney Int
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D.A. Shoskes et al.
Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection
Transplantation
(1998)

There are more references available in the full text version of this article.

Cited by (47)

Delayed Graft Function in Kidney Retransplantation: United Network for Organ Sharing Data With Linked Primary and Retransplant
2023, Journal of Surgical Research
There are several articles exploring the risk factors for primary delayed graft function (DGF). However, current literature does not include many resources on the risk factors for DGF when it is a recipient's second kidney transplant or look at short-term graft and patient survival of DGF retransplants.
United Network for Organ Sharing data from January 2008 to June 2021 were analyzed. Pancreas transplants, multi-organ transplants, and lost to follow-up transplants were excluded. Second transplant patients with DGF were identified. Multivariate logistic regression models based on the primary and second transplant characteristics were created. Survival analysis was performed with Kaplan-Meier methodology and assessed with log-rank test.
A total of 2964 second kidney transplants were identified. Rate of DGF in the second transplant was 28.4% (843/2964) and 49.2% of them had a prior DGF in their first transplant (P < 0.001). Multivariate analysis confirmed that occurrence of DGF (odds ratio [OR] 1.5, P < 0.001) and graft loss due to acute rejection (OR 1.2, P < 0.005) in the primary transplant were predictors of reappearing DGF in the second transplant. Dialysis at transplant was the greatest risk factor from the second transplant (OR 3.539, P < 0.001). There was a decreased graft survival after 12 mo (77% versus 49% with log t-test <0.001) in the second transplant. However, DGF was not significantly associated with patient survival.
This study shows the interaction between primary and second transplant in developing DGF. Survival analysis shows lower graft survival for retransplants in the case of DGF. This study opens the possibility of identifying additional risk factors for patients undergoing retransplant surgeries.
Long Hemodialysis Duration Predicts Delayed Graft Function in Renal Transplant Recipients From Living Donor: A Single-Center Study
2021, Transplantation Proceedings
This study aims to determine the ratio of delayed graft function in renal transplant recipients from living donors and the predictive value of hemodialysis time before transplant for delayed graft function.
We conducted a study on 116 adult patients who were diagnosed with end-stage kidney disease and were treated with hemodialysis and transplanted kidneys from living donors for 2 years (from June 2018 to June 2020). Delayed graft function event was collected for each patient.
The recipients had a median age of 36.5 years old, in which 55.2% of them were men, 4.3% of them had the diabetic mellitus, and the median hemodialysis duration was 6 months. The ratio of positive panel-reactive antibody was 33.6% and vascular reconstruction of the donor's kidney was 16.4%. The ratio of delayed graft function was 12.2% (14 of 116 patients). Delayed graft function significantly related to positive panel-reactive antibody, long duration of hemodialysis before transplant, and vascular reconstruction of donor's kidney with P < .001. Duration of hemodialysis before kidney transplant had a predictive value for delayed graft function (area under the curve, 0.83; P < .001).
Delayed graft function was not rare in renal transplant recipients from living donors. Duration of hemodialysis before kidney transplant was a good predictor for delayed graft function.
Effect of Cold Ischemia Time on Kidney Graft Function and Survival: Differences Between Paired Kidney Transplants From the Same Donor
2019, Transplantation Proceedings
Kidney transplantation procedures commonly result in a cold ischemia time (CIT) gap when both kidney grafts are implanted in the same center. Owing to logistics, the procedure is usually consecutive, first accomplishing one surgery and then the other. CIT constitutes an independent risk factor for the development of delayed graft function (DGF) in kidney transplants. The effect that CIT exerts on graft and patient survival is still unclear. This study evaluates the relation of CIT and transplant outcomes by comparing paired kidney transplants in terms of survival and graft function.
We accomplished a retrospective analysis of 402 kidney transplants performed in our center between 2000 and 2017. We selected all transplants where both organs from the same donor were implanted at our hospital, establishing 2 study groups (group 1: first graft implanted and group 2: second graft implanted) to compare by paired data statistical methods.
We found an increase in the incidence of DGF in group 2 (42% vs 28.8%; P < .05). Group 2 had significantly worse graft function on day 5 posttransplant (4.7 ± 2.88 vs 3.86 ± 2.8 mg/dL of serum creatinine; P < .05). No significant differences in graft function were found on days 30 and 90 posttransplant. We didn't find any difference in graft survival between both groups. Length of hospitalization stay (17.6 days [± 13] vs 21.6 days [± 17]) and hemodialysis sessions (mean of 2.8 [± 2] vs 3.6 [± 2.2]) were higher in group 2.
CIT acts as an independent risk factor for the development of DGF in kidney transplantation. CIT had no isolated effect on graft survival.
Shipping living donor kidneys and transplant recipient outcomes
2018, American Journal of Transplantation
Kidney paired donation (KPD) is an important tool to facilitate living donor kidney transplantation (LDKT). Concerns remain over prolonged cold ischemia times (CIT) associated with shipping kidneys long distances through KPD. We examined the association between CIT and delayed graft function (DGF), allograft survival, and patient survival for 1267 shipped and 205 nonshipped/internal KPD LDKTs facilitated by the National Kidney Registry in the United States from 2008 to 2015, compared to 4800 unrelated, nonshipped, non-KPD LDKTs. Shipped KPD recipients had a median CIT of 9.3 hours (range = 0.25-23.9 hours), compared to 1.0 hour for internal KPD transplants and 0.93 hours for non-KPD LDKTs. Each hour of CIT was associated with a 5% increased odds of DGF (adjusted odds ratio: 1.05, 95% confidence interval [CI], 1.02-1.09, P < .01). However, there was not a significant association between CIT and all-cause graft failure (adjusted hazard ratio [aHR]: 1.01, 95% CI: 0.98-1.04, P = .4), death-censored graft failure ( [aHR]: 1.02, 95% CI, 0.98-1.06, P = .4), or mortality (aHR 1.00, 95% CI, 0.96-1.04, P > .9). This study of KPD-facilitated LDKTs found no evidence that long CIT is a concern for reduced graft or patient survival. Studies with longer follow-up are needed to refine our understanding of the safety of shipping donor kidneys through KPD.
Predictive Factors for Improved Renal Function in Renal Transplantation Recipients
2020, Transplantation Proceedings
Citation Excerpt :
Meanwhile, arteries were categorized into single and multiple artery. The kidney side for the donors was grouped into left and right, and the DGF was divided into yes and no based on the presence of delay [17,18]. We used the statistical software SPSS version 16.0 (IBM Corp, Armonk, NY, United States) to perform χ2 testing on each parameter for bivariate analysis.
The purpose of this study is to analyze varying predictive factors for improved graft function among renal transplant recipients.
Two hundred eleven consecutive donor and recipient pairs who underwent renal transplantation between January 2011 and December 2015 were enrolled in our study. Factors that affected renal graft function were analyzed. Statistical analyses were performed using SPSS version 16.0 software (SPSS Inc, Chicago, IL, United States).
The mean age of donors in years was 30 (range, 17-62), with a mean body mass index (BMI) of 23.20 kg/m² (range, 16.10-39.50). Mean total warm ischemic time in minutes was 44.80 (range, 26.10-83.45). The mean age of the recipients in years was 48 (range, 12-78) with a mean BMI of 22 kg/m² (range, 14.80-37.30). Estimated glomerular filtration rate at 6 and 12 months post-transplantation were 69 mL per minute per 1.73 m² (range, 10-137) and 65 (range, 16-110), respectively. Based on several parameters, there was no significant factor that improved renal graft function at 6 and 12 months after transplant. Total warm ischemic time almost showed statistical significance in predicting improved renal graft function after transplant. Future study with a longer period of observation and a larger sample size should be done for further investigation.
Total warm ischemic time is a promising parameter to predict improved renal graft function post-transplantation.
CD8+CD69+and CD8+CD95+) Mediate Early Post-Transplant Acute Tubular Injury in Kidney Recipients
2023, Frontiers in Bioscience - Landmark

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Transplantation Proceedings

Abstract

Background

Results

Conclusions

Section snippets

Study design

Results

Discussion

Acknowledgments

References (7)

One-year posttransplant renal function is a strong predictor of long-term kidney function: results from the Neoral-MOST Observational Study

Transplant Proc

Post-transplant renal function in the first year predicts long-term kidney transplant survival

Kidney Int

Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection

Transplantation

Cited by (47)

Delayed Graft Function in Kidney Retransplantation: United Network for Organ Sharing Data With Linked Primary and Retransplant

Long Hemodialysis Duration Predicts Delayed Graft Function in Renal Transplant Recipients From Living Donor: A Single-Center Study

Effect of Cold Ischemia Time on Kidney Graft Function and Survival: Differences Between Paired Kidney Transplants From the Same Donor

Shipping living donor kidneys and transplant recipient outcomes

Predictive Factors for Improved Renal Function in Renal Transplantation Recipients

CD8<sup><sup>+</sup></sup>CD69<sup><sup>+</sup></sup>and CD8<sup><sup>+</sup></sup>CD95<sup><sup>+</sup></sup>) Mediate Early Post-Transplant Acute Tubular Injury in Kidney Recipients

Ischemia-reperfusion injuryKidneyDelayed graft function: Risk factors, consequences and parameters affecting outcome—results from MOST, A Multinational Observational Study

Abstract

Background

Results

Conclusions

Section snippets

Study design

Results

Discussion

Acknowledgments

Transplant Proc

Kidney Int

Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection

Transplantation

Ischemia-reperfusion injury
Kidney
Delayed graft function: Risk factors, consequences and parameters affecting outcome—results from MOST, A Multinational Observational Study