Prediction of kidney transplant outcome based on different DGF definitions in Chinese deceased donation

BMC Nephrol. 2019 Nov 13;20(1):409. doi: 10.1186/s12882-019-1557-x.

Abstract

Background: Delayed graft function (DGF) is an important complication of kidney transplantation and can be diagnosed according to different definitions. DGF has been suggested to be associated with the long-term outcome of kidney transplantation surgery. However, the best DGF definition for predicting renal transplant outcomes in Chinese donations after cardiac death (DCDs) remains to be determined.

Method: A total of 372 DCD kidney transplant recipients from June 2013 to July 2017 in the First Affiliated Hospital of Xi'an Jiaotong University were included in this retrospective study to compare 6 different DGF definitions. The relationships of the DGF definitions with transplant outcome were analyzed, including graft loss (GL) and death-censored graft loss (death-censored GL). Renal function indicators, including one-year estimated glomerular filtration rate (eGFR) and three-year eGFR, and were compared between different DGF groups.

Results: The incidence of DGF varied from 4.19 to 35.22% according to the different DGF diagnoses. All DGF definitions were significantly associated with three-year GL as well as death-censored GL. DGF based on requirement of hemodialysis within the first week had the best predictive value for GL (AUC 0.77), and DGF based on sCr variation during the first 3 days post-transplant had the best predictive value for three-year death-censored GL (AUC 0.79). Combination of the 48-h sCr reduction ratio and classical DGF can improve the AUC for GL (AUC 0.85) as well as the predictive accuracy for death-censored GL (83.3%).

Conclusion: DGF was an independent risk factor for poor transplant outcome. The combination of need for hemodialysis within the first week and the 48-h serum creatinine reduction rate has a better predictive value for patient and poor graft outcome.

Keywords: Definitions; Delayed graft function; Donation after cardiac death; Kidney transplant outcome.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Area Under Curve
  • China
  • Creatinine / blood
  • Delayed Graft Function / diagnosis*
  • Delayed Graft Function / epidemiology
  • Female
  • Glomerular Filtration Rate
  • Graft Survival
  • Heart Arrest
  • Humans
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Kaplan-Meier Estimate
  • Kidney / physiology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / mortality
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / epidemiology
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Time Factors
  • Tissue Donors*
  • Treatment Outcome

Substances

  • Immunosuppressive Agents
  • Creatinine