A Risk Prediction Model for Delayed Graft Function in the Current Era of Deceased Donor Renal Transplantation

Biostatistics and Health Outcomes Research, CTI Clinical Trial and Consulting Services, Cincinnati, OH, USA.
American Journal of Transplantation (Impact Factor: 5.68). 10/2010; 10(10):2279-86. DOI: 10.1111/j.1600-6143.2010.03179.x
Source: PubMed


Delayed graft function (DGF) impacts short- and long-term outcomes. We present a model for predicting DGF after renal transplantation. A multivariable logistic regression analysis of 24,337 deceased donor renal transplant recipients (2003-2006) was performed. We developed a nomogram, depicting relative contribution of risk factors, and a novel web-based calculator (http://www.transplantcalculator.com/DGF) as an easily accessible tool for predicting DGF. Risk factors in the modern era were compared with their relative impact in an earlier era (1995-1998). Although the impact of many risk factors remained similar over time, weight of immunological factors attenuated, while impact of donor renal function increased by 2-fold. This may reflect advances in immunosuppression and increased utilization of kidneys from expanded criteria donors (ECDs) in the modern era. The most significant factors associated with DGF were cold ischemia time, donor creatinine, body mass index, donation after cardiac death and donor age. In addition to predicting DGF, the model predicted graft failure. A 25-50% probability of DGF was associated with a 50% increased risk of graft failure relative to a DGF risk < 25%, whereas a > 50% DGF risk was associated with a 2-fold increased risk of graft failure. This tool is useful for predicting DGF and long-term outcomes at the time of transplant.

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Available from: Mark A Schnitzler, Feb 28, 2014
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    • "Area under the ROC curves derived from our logistic regression analyses, close to 0.77, shows an excellent discriminant power of the risk factors identified in our model and compares favourably with that reported (0.70) in a large multicentric study [3]. Moreover, restricting the analysis to the 236 grafts performed in our centre between 2003 and 2006, the DGF probability is 11% when using the twentytwo risk factors provided by the transplant calculator derived from the data of 2003–2006 [3] "
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    ABSTRACT: Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient's perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2-2.9]). Moreover, we observed two novel risk factors for DGF: patient's residual diuresis ≤500 mL/d (OR = 2.3 [1.6-3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0-5.4]). Area under the curve of the ROC curve (0.77 [0.74-0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival (P = 0.54). However, graft survival is decreased only when rejection was associated with DGF (P < 0.001). Conclusions. Perioperative saline loading efficiently prevents ischemia-reperfusion injury, which is the predominant factor inducing DGF. DGF per se has no influence on patient and graft outcome. Its incidence is currently close to 5% in our centre.
    Journal of Transplantation 10/2015; 2015(5):163757. DOI:10.1155/2015/163757
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    • "For these patients, a successful transplantation provides significantly higher survival rates and better quality of life compared with dialysis [1]. In the past few years, there has been a tremendous improvement in short-term renal allograft survival, but no corresponding improvement in long-term results [2]. Great progress in surgical and preservation techniques, better use of immunosuppressants, and improved tissue typing and immunosupression therapy have not significantly improved long-term graft survival so far [3]. "
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    ABSTRACT: Results. Univariate analysis showed significantly shorter renal graft function in the group of recipients with higher creatinine levels in all of the analyzed time periods and in patients experiencing delayed graft function. Length of time of hemodialyses after transplantation and number of dialyses had significant impact on worsening of late transplant results. Multivariate analysis reported that early graft rejection in the postoperative period is an independent factor improving late graft function: P =.002; hazard ratio (HR), 0.49 (95% confidence interval [CI], 0.31-0.78). Higher creatinine level at day 90 after kidney transplantation is a predictive factor of late graft dysfunction: P =.002; HR, 1.68 (95% CI 1.2-2.35).
    Transplantation Proceedings 10/2014; 46(8):2696-8. DOI:10.1016/j.transproceed.2014.08.016 · 0.98 Impact Factor
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    • "The quality of the transplanted organ, as well as the timing of the initiation of its effective function, depends on many factors potentially causing graft dysfunction. Postoperative graft function is not exclusively determined by pretransplantation donor and graft characteristics [2] [3]. Several lines of evidence indicate that the hemodynamic status of the donor before organ retrieval is associated with initial graft function [4]. "
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    ABSTRACT: Background: The quality of transplanted organ and timing of the initiation of its effective function depends on many factors potentially causing graft dysfunction. The aim of this study was to evaluate the influence of the cardiovascular status of multiorgan donors on the long-term kidney graft survival over a 15-year observation period. Methods: In 2007, the authors of this study published a multicenter prospective study evaluating the influence of the hemodynamic status of multiorgan donors on the early function of transplanted kidney. The results of that study showed that mean arterial pressure, central venous pressure, and pulmonary capillary wedge pressure values of the donor importantly influence the frequency of delayed graft function after renal transplantation. The present analysis covers the effect of the donor's hemodynamic status parameters on graft function time within the 15-year observation period. Univariate and multivariate analyses using the Cox regression proportional hazard model were performed to evaluate the prognostic parameters for overall survival and renal graft survival time. P < .05 was considered to be significant. Results: The univariate analysis showed a significantly shorter time of graft survival in the group of recipients who had a kidney retrieved from donors with lower pulmonary capillary wedge pressure values (P = .038) and lower cardiac index values (P = .039). The same results were obtained for the multifactorial Cox logistic regression analysis. Conclusions: The filling of the intravascular bed of the donor as determined by pulmonary capillary wedge pressure and maintained donor tissue perfusion as determined by cardiac index, impose important factors influencing long-term kidney graft survival.
    Transplantation Proceedings 10/2014; 46(8). DOI:10.1016/j.transproceed.2014.08.017 · 0.98 Impact Factor
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