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Transplantation. 2017 Aug;101(8):1913-1923. doi: 10.1097/TP.0000000000001409.

Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes.

Author information

1
1 Division of Nephrology, Hypertension & Renal Transplantation, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT. 2 Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA. 3 Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA. 4 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA. 5 Division of Nephrology, Department of Medicine, Wayne State University, Detroit, MI. 6 Saint Barnabas Medical Center, Livingston, NJ. 7 Section of Nephrology, University Hospital, Ulm, Germany. 8 Section of Nephrology, Yale University School of Medicine, New Haven, CT. 9 Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT. 10 Veterans Affairs Connecticut Healthcare System, New Haven, CT.

Abstract

BACKGROUND:

Ischemia-reperfusion injury (IRI) leading to delayed graft function (DGF), defined by the United Network for Organ Sharing as dialysis in the first week (UNOS-DGF), associates with poor kidney transplant outcomes. Controversies remain, however, about dialysis initiation thresholds and the utility for other criteria to denote less severe IRI, or slow graft function (SGF).

METHODS:

Multicenter, prospective study of deceased-donor kidney recipients to compare UNOS-DGF to a definition that combines impaired creatinine reduction in the first 48 hours or greater than 1 dialysis session for predicting 12-month estimated glomerular filtration rate (eGFR). We also assessed 10 creatinine and urine output-based SGF definitions relative to 12-month eGFR.

RESULTS:

In 560 recipients, 215 (38%) had UNOS-DGF, 330 (59%) met the combined definition, 14 (3%) died, and 23 (4%) had death-censored graft failure by 12 months. Both DGF definitions were associated with lower adjusted 12-month eGFR (95% confidence interval)-by 7.3 (3.6-10.9) and 7.4 (3.8-11.0) mL/min per 1.73 m, respectively. Adjusted relative risks for 12-month eGFR less than 30 mL/min per 1.73 m were 1.9 (1.2-3.1) and 2.1 (1.1-3.7), with unadjusted areas under the curve of 0.618 and 0.627, respectively. For SGF definitions, postoperative day (POD) 7 creatinine had the strongest association with 12-month eGFR, and POD5 creatinine and creatinine reduction between POD1 and POD2 demonstrated modest separations in 12-month eGFR.

CONCLUSIONS:

Although UNOS-DGF does not adequately predict 12-month function on its own, our findings do not support changing the definition. Postoperative day 7 creatinine is correlated with 12-month eGFR, but large translational studies are needed to understand the biological link between IRI severity at transplant and longer-term outcomes.

PMID:
27495761
PMCID:
PMC5292094
[Available on 2018-08-01]
DOI:
10.1097/TP.0000000000001409
[Indexed for MEDLINE]
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