Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome
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...
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| Language: | English |
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Wiley
2015-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2015/163757 |
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| author | Martin Chaumont Judith Racapé Nilufer Broeders Fadoua El Mountahi Annick Massart Thomas Baudoux Jean-Michel Hougardy Dimitri Mikhalsky Anwar Hamade Alain Le Moine Daniel Abramowicz Pierre Vereerstraeten |
| author_facet | Martin Chaumont Judith Racapé Nilufer Broeders Fadoua El Mountahi Annick Massart Thomas Baudoux Jean-Michel Hougardy Dimitri Mikhalsky Anwar Hamade Alain Le Moine Daniel Abramowicz Pierre Vereerstraeten |
| author_sort | Martin Chaumont |
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| description | 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. |
| format | Article |
| id | doaj-art-3317ffe0c47142ab8a0d387e13cf38b7 |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-3317ffe0c47142ab8a0d387e13cf38b72025-02-03T06:01:14ZengWileyJournal of Transplantation2090-00072090-00152015-01-01201510.1155/2015/163757163757Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft OutcomeMartin Chaumont0Judith Racapé1Nilufer Broeders2Fadoua El Mountahi3Annick Massart4Thomas Baudoux5Jean-Michel Hougardy6Dimitri Mikhalsky7Anwar Hamade8Alain Le Moine9Daniel Abramowicz10Pierre Vereerstraeten11Department of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumResearch Center of Biostatistics, Epidemiology and Clinical Research, School of Public Health, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumNephrology Department, Antwerp University Hospital, Free University of Brussels, Wilrijkstraat 10, 2650 Edegem, BelgiumDepartment of Nephrology, Dialysis and Transplantation and Department of Abdominal Surgery, CUB, Erasmus Hospital, Route de Lennik 808, 1070 Brussels, BelgiumBackground. 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.http://dx.doi.org/10.1155/2015/163757 |
| spellingShingle | Martin Chaumont Judith Racapé Nilufer Broeders Fadoua El Mountahi Annick Massart Thomas Baudoux Jean-Michel Hougardy Dimitri Mikhalsky Anwar Hamade Alain Le Moine Daniel Abramowicz Pierre Vereerstraeten Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome Journal of Transplantation |
| title | Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome |
| title_full | Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome |
| title_fullStr | Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome |
| title_full_unstemmed | Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome |
| title_short | Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome |
| title_sort | delayed graft function in kidney transplants time evolution role of acute rejection risk factors and impact on patient and graft outcome |
| url | http://dx.doi.org/10.1155/2015/163757 |
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