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Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation:A retrospective,single center study

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World Journal of Transplantation 2021年第4期11卷 114-128页

作者： Nicholas V Mendez Yehuda Raveh Joshua J Livingstone Gaetano Ciancio Giselle Guerra George W Burke III Vadim B Shatz Fouad G Souki Linda J Chen Mahmoud Morsi Jose M Figueiro Tony M Ibrahim Werviston L DeFaria Ramona Nicolau-Raducu Department of Anesthesiology University of Miami/Jackson Memorial HospitalMiamiFL 33136United States Department of Surgery Miami Transplant Institute/University of Miami/Jackson Memorial HospitalMiamiFL 33136United States Division of Nephrology of the Department of Medicine University of Miami/Jackson Memorial HospitalMiamiFL 33136United States

BACKGROUND There is an abundant need to increase the availability of deceased donor kidney transplantation(DDKT)to address the high incidence of kidney *** exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients;thus the identification of modifiable risk factors associated with poor outcomes is *** To identify risk factors associated with delayed graft function(DGF).METHODS Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 *** primary outcome was the occurrence of *** The incidence of DGF was 27%.Under logistic regression,eight independent risk factors for DGF were identified including recipient body mass index≥30 kg/m^(2),baseline mean arterial pressure<110 mmHg,intraoperative phenylephrine administration,cold storage time≥16 h,donation after cardiac death,donor history of coronary artery disease,donor terminal creatinine≥1.9 mg/dL,and a hypothermic machine perfusion(HMP)pump resistance≥0.23 mmHg/mL/*** We delineate the association between DGF and recipient characteristics of preinduction mean arterial pressure below 110 mmHg,metabolic syndrome,donorspecific risk factors,HMP pump parameters,and intraoperative use of phenylephrine.

关键词： delayed graft function Outcome Kidney transplant Risk factors Phenylephrine Mean arterial pressure

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Predictive Score Model for delayed graft function Based on Easily Available Variables before Kidney Donation after Cardiac Death

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Chinese Medical Journal 2017年第20期130卷 2429-2434页

作者： Chen-Guang Ding Qian-Hui Tai Feng Han Yang Li Xiao-Hui Tian Pu-Xun Tian Xiao-Ming Ding Xiao-Ming Pan Jin Zheng He-Li Xiang Wu-Jun Xue Department of Renal Transplantation Nephropathy Hospital The First Affiliated Hospital of Xi'an Jiaotong University Xi'an Shaanxi 710061 China Institute of Organ Transplantation Xi'an Jiaotong University Xi'an Shaanxi 710061 China

Background： How to evaluate the quality of donation after cardiac transplantation in China. Hence, the aim of this study was to develop kidneys before DCD. death （DCD） kidneys has become a critical problem in kidney a simple donor risk score model to evaluate the quality of DCD Methods： A total of 543 qualified kidneys were randomized in a 2：1 manner to create the development and validation cohorts. The donor variables in the development cohort were considered as candidate univariate predictors of delayed graft function （DGF）. Multivariate logistic regression was then used to identify independent predictors of DGF with P 〈 0.05. Date from validation cohort were used to validate the donor scoring model. Results： Based on the odds ratios, eight identified variables were assigned a weighted integer; the sum of the integer was the total risk score for each kidney. The donor risk score, ranging from 0 to 28, demonstrated good discriminative power with a C-statistic of 0.790. Similar results were obtained from validation cohort with C-statistic of 0.783. Based on the obtained frequencies of DGF in relation to different risk scores, we formed tour risk categories of increasing severity （scores 04, 5 9, 10-14, and 15 28）. Conclusions： The scoring model might be a good noninvasive tool for assessing the quality of DCD kidneys before donation and potentially useful for physicians to make optimal decisions about donor organ offers.

关键词： delayed graft function Donation after Cardiac Death Kidney Transplantation Predictive Score

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Risk factors for delayed graft function in cardiac death donor renal transplants

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Chinese Medical Journal 2012年第21期125卷 3782-3785页

作者： SHAO Ming-jie YE Qi-fa MING Ying-zi SHE Xing-guo LIU Hong YE Shao-jun NIU Ying Research Center of Chinese Health Ministry of TransplantationMedicine Engineering and Technology Third Affiliated ttospitalCentral South UniversityChangshaHunan 410013China

Background delayed graft function （DGF） is common in kidney transplants from organ donation after cardiac death （DCD） donors. It is associated with various factors. Determination of center-specific risk factors may help to reduce the incidence of DGF and improve the transplantation results. The aim of this study is to define risk factors of DGF after renal transplantation.

关键词： delayed graft function donation after cardiac death," risk Jactors

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Successful kidney transplantation from an expanded criteria donor with long-term extracorporeal membrane oxygenation treatment: A case report

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World Journal of Clinical Cases 2020年第3期8卷 540-545页

作者： Hye Won Seo Sua Lee Hwa Young Lee Sun Cheol Park Byung Ha Chung Chul Woo Yang Tae Hyun Ban Division of Nephrology Department of Internal MedicineSeoul St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 06591South Korea Transplant Research Center Department of Internal MedicineSeoul St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 06591South Korea Division of Nephrology Department of Internal MedicineJeju National University HospitalJeju-do 63241South Korea Department of Surgery Seoul St.Mary’s HospitalCollege of MedicineThe Catholic University of Korea222 Banpo-daeroSeoul 06591South Korea Division of Nephrology Department of Internal MedicineEunpyeong St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaEunpyeong-guSeoul 03312South Korea

BACKGROUND Due to a shortage of donor kidneys, many centers have utilized graft kidneys from brain-dead donors with expanded criteria. Kidney transplantation(KT)from donors on extracorporeal membrane oxygenation(ECMO) has been identified as a successful way of expanding donor pools. However, there are currently no guidelines or recommendations that guarantee successful KT from donors undergoing ECMO treatment. Therefore, acceptance of appropriate allografts from those donors is solely based on clinician *** SUMMARY We report a case of successful KT from a brain-dead donor supported by ECMO for the longest duration to date. A 69-year-old male received a KT from a 63-yearold brain-dead donor who had been on therapeutic ECMO treatment for the previous three weeks. The recipient experienced slow recovery of graft function after surgery but was discharged home on post-operative day 17 free from hemodialysis. Allograft function gradually improved thereafter and was comparatively acceptable up to the 12 mo follow-up, with serum creatinine level of 1.67 mg/d *** This case suggests that donation even after long-term ECMO treatment could provide successful KT to suitable candidates.

关键词： Extracorporeal membrane oxygenation Kidney transplantation delayed graft function Donor selection Case report

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Values of Donor Serum Lipids and Calcium in Predicting graft function after Kidney Transplantation:A Retrospective Study

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当代医学科学(英文) 2023年第3期43卷 514-519页

作者： Hui-bo SHI Yuan-yuan ZHAO Yu LI Yi LI Bin LIU Nian-qiao GONG Sheng CHANG Dun-feng DU Lan ZHU Jing XU Xiao-qin LI Meng-jun ZENG Shang-xin DONG Zhi-shui CHEN Ji-pin JIANG Institute of Organ Transplantation Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyKey Laboratory of Organ TransplantationMinistry of EducationMinistry of Public HealthChinese Academy of Medical SciencesWuhan430030China The Organ Procurement Organizations Ofice Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Objective delayed graft function(DGF)and early graft loss of renal grafts are determined by the quality of the kidneys from the deceased ***“non-traditional”risk factors,serum biomarkers of donors,such as lipids and electrolytes,have drawn increasing attention due to their effects on the postoperative outcomes of renal *** study aimed to examine the value of these serum biomarkers for prediction of renal graft *** The present study consecutively collected 306 patients who underwent their first single kidney transplantation(KT)from adult deceased donors in our center from January 1,2018 to December 31,*** correlation between postoperative outcomes[DGF and abnormal serum creatinine(SCr)after 6 and 12 months]and risk factors of donors,including gender,age,body mass index(BMI),past histories,serum lipid biomarkers[cholesterol,triglyceride,high-density lipoprotein(HDL)and low-density lipoprotein(DL)],and serum electrolytes(calcium and sodium)were analyzed and ***(1)Donor age and pre-existing hypertension were significantly correlated with the incidence rate of DGF and high SCr level(≥2 mg/dL)at 6 and 12 months after KT(Pgrafts after KT,in addition to the donor’s age,BMI and pre-existing hypertension.

关键词： delayed graft function serum creatinine serum high-density lipoprotein serum calcium kidney transplantation

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Innovative immunosuppression in kidney transplantation:A challenge for unmet needs

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World Journal of Transplantation 2022年第3期12卷 27-41页

作者： Maurizio Salvadori Aris Tsalouchos Department of Renal Transplantation Careggi University HospitalFlorence 50139Italy Division of Nephrology Santa Maria Annunziata HospitalFlorence 50012Italy

Due to the optimal results obtained in kidney transplantation and to the lack of interest of the industries,new innovative drugs in kidney transplantation are difficult to be *** best strategy to find the new drugs recently developed or under development is to search in the sections of kidney transplantation still not completely covered by the drugs on the *** unmet needs are the prevention of delayed graft function(DGF),the protection of the graft over the long time and the desensitization of preformed anti human leukocyte antigen antibodies and the treatment of the acute antibody-mediated *** needs are particularly relevant due to the expansion of some kind of kidney transplantation as transplantation from non-heart beating donor and in the case of antibody-incompatible *** first are particularly exposed to DGF,the latter need a safe desensitization and a safe treatments of the antibody mediated rejections that often *** caution is needed in treating these ***,they are described in very recent studies and the follow-up of their effect is of course rather ***,some of these drugs are still in an early phase of study,even if in well-conducted randomized controlled *** caution and a careful check need to be used in trials launched 2 or 3 years ***,is always necessary to verify whether the study is still going on or whether and why the study itself was abandoned.

关键词： New drugs Unmet needs in kidney transplantation delayed graft function Long-term outcomes Kidney inflammation Anti-human leukocyte antigen antibodies

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Changes in biochemical parameters on the first day after kidney transplantation： risk factors for nosocomial infection？

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Chinese Medical Journal 2010年第5期123卷 563-568页

作者： YANG Yi REN Liang ZHANG Yong LIU Hang CAO Bin ZHANG Xiao-dong Department of Urology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Infectious Disease Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

Background Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations. Methods Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function （DGF） and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 （before transplantation） and day 1 （24 hours after transplantation） and their changes were analyzed with Logistic regression models for nosocomial infection. Results A total of 405 patients （315 men and 90 women） were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were indentified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein （a）（Lp（a）） on day 1, change in low density lipoprotein-cholesterol （LDL-C, day 1-day 0） and change in uric acid （day 1-day 0） between nosocomial infection patients and noninfectious patients （P 〈0.05）. In multivariate analysis, change in uric acid （day 1-day 0）（OR 5.139, 95% CI 1.176-22.465, P 〈0.05）, change in LDL-C （day 1-day 0）（OR4.179, 95% CI 1.375-12.703, P 〈0.05） and DGF （OR 14.409, 95% CI 1.603-129.522, P 〈0.05） were identified as independent risk factors for nosocomial infection in kidney transplantation. Conclusions Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract, u

关键词： delayed graft function cholesterol, low density lipoprotein cross infection kidney transplantation uric acid

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Predictive value of hypothermic machine perfusion parameters combined perfusate biomarkers in deceased donor kidney transplantation

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Chinese Medical Journal 2022年第2期135卷 181-186页

作者： Yuxi Qiao Chenguang Ding Yang Li Xiaohui Tian Puxun Tian Xiaoming Ding Heli Xiang Jin Zheng Wujun Xue Department of Kidney Transplantation The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710061China Institute of Organ Transplantation The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710061China

Background:delayed graft function(DGF)is the main cause of renal function failure after kidney *** study aims at investigating the value of hypothermic machine perfusion(HMP)parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor(DD)kidney ***:HMP parameters,perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1,2019 to August 31,2019 in the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression ***:In this study,the DGF incidence was 17.7%(20/113);The multivariate logistic regression results showed that terminal resistance(OR:1.879,95%CI 1.145-3.56)and glutathione S-transferase(GST)(OR=1.62,95%CI 1.23-2.46)were risk factors for DGF;The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time(HR=0.823,95%CI 0.735-0.981).The model combining terminal resistance and GST(AUC=0.888,95%CI:0.842-0.933)significantly improved the DGF predictability compared with the use of terminal resistance(AUC=0.756,95%CI 0.693-0.818)or GST alone(AUC=0.729,95%CI 0.591-0.806).Conclusion:According to the factors analyzed in this study,the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.

关键词： Hypothermic machine perfusion Perfusate biomarker Kidney transplantation delayed graft function Prognosic factors

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The Effect of Non-Invasive Goal Directed Fluid Administration on graft function in Deceased Donor Renal Transplantation: A Pilot Study

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Open Journal of Organ Transplant Surgery 2016年第3期6卷 13-21页

作者： Joseph R. Whiteley Jason M. Taylor John J. Freely Jr. Thomas I. Epperson Laura Bell John L. Murray IV Charles F. Bratton William R. Hand Department of Anesthesia and Perioperative Medicine Medical University of South Carolina Charleston USA Department of Anesthesiology Columbia University Medical Center New York USA Medical University of South Carolina College of Medicine Charleston USA Department of Surgery Division of Transplant Surgery Charleston USA

Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.

关键词： Deceased Donor Renal Transplant Non-Invasive Goal Directed Fluid Therapy delayed graft function Plethysmograph Variability Index

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Kidney donation after cardiac death

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World Journal of Nephrology 2012年第3期1卷 79-91页

作者： Jacob A Akoh South West Transplant Centre Plymouth Hospi-tals NHS TrustDerriford HospitalPlymouth PL6 8DHUnited Kingdo

There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to con-trolled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function （DGF） and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that signifcantly infuences the outcome of allografts, for example, limiting it to 〈 12 h markedly reduces DGF. DCD kidneys from donors 〈 50 function like stan-dard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled dona-tion, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kid-neys from DCD include： implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

关键词： Donation after cardiac death Donation after brain death Extended criteria donor Viability assessment Renal transplantation delayed graft function graft survival Agonal phase Kidney preservation

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