Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Hall, Isaac E.; Reese, Peter P.; Doshi, Mona D.; Weng, Francis L.; Schröppel, Bernd; Asch, William S.; Ficek, Joseph; Thiessen-Philbrook, Heather; Parikh, Chirag R.
• Is Part Of: Transplantation. Volume 101:Issue 8(2017)
• Publication Date: 2017-08
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000001409
• Languages: English
• ISSNs: 0041-1337

Abstract

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 2, respectively. Adjusted relative risks for 12-month eGFR less than 30 mL/min per 1.73 m 2 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. Abstract : This multicenter observation cohort study shows that a new delayed graft function definition (impaired creatinine reduction in the first 48 hours or >1 dialysis session) is not better than the UNOS definition (dialysis in the first week) to predict 12-month renal function. Supplemental digital content is available in the text.