Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Mark A Schnitzler, Feb 28, 2014
  • Source
    • "Grafts that never functioned due to technical failures, arterial and/or venous thrombosis (í µí±› = 33), primary nonfunction (í µí±› = 9), or urological problems (í µí±› = 8), were not considered as DGF, as regular dialysis was not interrupted. Most recipient, donor, and transplant characteristics reported in the literature as risk factors for DGF were considered [3]. Some of them were rather infrequent in our centre and were therefore not taken into account, such as recipient's ethnicity (3% black Africans), machine-perfusion preservation (0.3%), and extended criteria donors (6.3% in 2013) [22], and were therefore not considered in further analyses. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Oct 2015 · Journal of Transplantation
  • Source
    • "However, although the risk factors for DGF have been well-described in the literature for a number of years, it is difficult to predict this complication in practice at an individual level. Several scoring systems have been proposed within the last few years[3,4], but these are not used routinely for medical decision making because of the important number of included parameters or the absence of validation. Therefore, we recently proposed an alternative scoring system entitled the delayed graft function score (DGFS)[5]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In kidney transplantation, the use of Anti-Thymocyte Globulins (ATG) as induction therapy has been described as a possible treatment for reducing the prevalence of Delayed Graft Function (DGF). ATG possesses pharmaceutical proprieties that could help control the lesions caused by ischemia reperfusion injury. However, other studies have questioned this potential protective effect. We hypothesized that the benefits related to ATG for reducing DGF prevalence may be higher and more consistently recognized if only patients with high DGF risk are considered. We recently proposed a scoring system entitled DGFS (Delayed Graft Function Score) for such stratification of kidney transplant recipients according to their risk of DGF. Using the DGFS calculation, we aim to determine whether a short course of ATG can decrease the incidence of DGF in comparison with Basiliximab in kidney transplant recipients with low immunological risk but high DGF risk. We conduct a phase IV, open label, randomized, multicentric and prospective study, to compare ATG in parallel with a control group treated by Basiliximab. The 1:1 randomized allocation of patients between groups is stratified on the clinical center, and on the hypothermic machine-perfusion device. We aimed to include a total of 384 patients to achieve a statistical power at 0.80. The study was initiated at the Nantes University hospital in July 2014, with data collection continuing until April 2018, and publication of the results proposed for 2019. The main expected benefits of this study are i) the reduction of unjustified ATG over-prescriptions associated with serious adverse events, ii) the reduction of chance losses related to ATG under-prescription, iii) the decrease in the incidence of DGF which was described as a risk factor of graft failure and patient death, and iv) the reduction in hospitalization duration and number of post transplantation dialysis sessions, both being associated with reduced medical costs. In conclusion, the current study is innovative by proposing a more efficient and personalized induction therapy. The study was registered in the Clinical Trials Registry (# NCT02056938 , February 5, 2014), and in the European Clinical Trials Database (EudraCT #2014-000332-42, January 30, 2014).
    Full-text · Article · Jun 2015 · Trials
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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).
    Full-text · Article · Oct 2014 · Transplantation Proceedings
Show more