TY - JOUR
T1 - The impact of functional delayed graft function in the modern era of kidney transplantation – A retrospective study
AU - Montagud-Marrahi, Enrique
AU - Molina-Andújar, Alícia
AU - Rovira, Jordi
AU - Revuelta, Ignacio
AU - Ventura-Aguiar, Pedro
AU - Piñeiro, Gastón
AU - Ugalde-Altamirano, Jessica
AU - Perna, Francesco
AU - Torregrosa, Jose Vicente
AU - Oppenheimer, Federico
AU - Esforzado, Nuria
AU - Cofán, Frederic
AU - Campistol, Josep M.
AU - Herrera-Garcia, Adriana
AU - Ríos, Jose
AU - Diekmann, Fritz
AU - Cucchiari, David
N1 - Funding Information:
This study has been partially funded by Redes Temáticas De Investigación Cooperativa En Salud, REDINREN (RD16/0009/0023) co‐funded by ISCIII‐Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER) “Una manera de hacer Europa”. CERCA Programme/Generalitat de Catalunya.
Funding Information:
FD has received research grants and speaker fees from Astellas, CSL Behring, Mallinckrodt, Novartis, Pfizer, Transplant Biomedicals. DC has received speaker fees from Novartis and travel grant from Novartis and Astellas. All the other Authors do not report any relevant conflict of interest.
Publisher Copyright:
© 2020 Steunstichting ESOT. Published by John Wiley & Sons Ltd
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - The dialysis-based definition of Delayed Graft Function (dDGF) is not necessarily objective as it depends on the individual physician’s decision. The functional definition of DGF (fDGF, the failure of serum creatinine to decrease by at least 10% daily on 3 consecutive days during the first week post-transplant), may be more sensitive to reflect recovery after the ischemia-reperfusion injury. We retrospectively analyzed both definitions in 253 deceased donor kidney transplant recipients for predicting death-censored graft failure as primary outcome, using eGFR < 25 ml/min/1.73 m2 as a surrogate end-point for graft failure. Secondary outcome was a composite outcome that included graft failure as above and also patient’s death. Median follow-up was 3.22 [2.38–4.21] years. Seventy-nine patients developed dDGF (31.2%) and 127 developed fDGF (50.2%). Sixty-three patients fulfilled criteria for both definitions (24.9%). At multivariable analysis, the two definitions were significantly associated with the primary [HR (95%CI) 2.07 (1.09–3.94), P = 0.026 for fDGF and HR (95%CI) 2.41 (1.33–4.37), P = 0.004 for dDGF] and the secondary composite outcome [HR (95%CI) 1.58 (1.01–2.51), P = 0.047 for fDGF and HR (95%CI) 1.67 (1.05–2.66), P = 0.028 for dDGF]. Patients who met criteria for both definitions had the worst prognosis, with a three-year estimates (95%CI) of survival from the primary and secondary outcomes of 2.31 (2.02–2.59) and 2.20 (1.91–2.49) years for fDGF+/dDGF+, in comparison with the other groups (P < 0.01 for trend). fDGF provides supplementary information about graft outcomes on top of the dDGF definition in a modern series of kidney transplantation.
AB - The dialysis-based definition of Delayed Graft Function (dDGF) is not necessarily objective as it depends on the individual physician’s decision. The functional definition of DGF (fDGF, the failure of serum creatinine to decrease by at least 10% daily on 3 consecutive days during the first week post-transplant), may be more sensitive to reflect recovery after the ischemia-reperfusion injury. We retrospectively analyzed both definitions in 253 deceased donor kidney transplant recipients for predicting death-censored graft failure as primary outcome, using eGFR < 25 ml/min/1.73 m2 as a surrogate end-point for graft failure. Secondary outcome was a composite outcome that included graft failure as above and also patient’s death. Median follow-up was 3.22 [2.38–4.21] years. Seventy-nine patients developed dDGF (31.2%) and 127 developed fDGF (50.2%). Sixty-three patients fulfilled criteria for both definitions (24.9%). At multivariable analysis, the two definitions were significantly associated with the primary [HR (95%CI) 2.07 (1.09–3.94), P = 0.026 for fDGF and HR (95%CI) 2.41 (1.33–4.37), P = 0.004 for dDGF] and the secondary composite outcome [HR (95%CI) 1.58 (1.01–2.51), P = 0.047 for fDGF and HR (95%CI) 1.67 (1.05–2.66), P = 0.028 for dDGF]. Patients who met criteria for both definitions had the worst prognosis, with a three-year estimates (95%CI) of survival from the primary and secondary outcomes of 2.31 (2.02–2.59) and 2.20 (1.91–2.49) years for fDGF+/dDGF+, in comparison with the other groups (P < 0.01 for trend). fDGF provides supplementary information about graft outcomes on top of the dDGF definition in a modern series of kidney transplantation.
KW - delayed graft function
KW - dialysis delayed graft function
KW - functional delayed graft function
KW - graft survival
KW - kidney transplantation
KW - recipient survival
UR - http://www.scopus.com/inward/record.url?scp=85096832762&partnerID=8YFLogxK
U2 - 10.1111/tri.13781
DO - 10.1111/tri.13781
M3 - Artículo
C2 - 33131120
AN - SCOPUS:85096832762
VL - 34
SP - 175
EP - 184
JO - Transplant International
JF - Transplant International
SN - 0934-0874
IS - 1
ER -