Top

World Journal of Urology

Published in:

Open Access 01-08-2013 | Original Article

Poor early graft function impairs long-term outcome in living donor kidney transplantation

Authors: J. Hellegering, J. Visser, H. J. Kloke, F. C. H. D’Ancona, A. J. Hoitsma, J. A. van der Vliet, M. C. Warlé

Published in: World Journal of Urology | Issue 4/2013

Abstract

Background

Poor early graft function (EGF) after living donor kidney transplantation (LDKT) has been found to decrease rejection-free graft survival rates. However, its influence on long-term graft survival remains inconclusive.

Methods

Data were collected on 472 adult LDKTs performed between July 1996 and February 2010. Poor EGF was defined as the occurrence of delayed or slow graft function. Slow function was defined as serum creatinine above 3.0 mg/dL at postoperative day 5 without dialysis.

Results

The incidence of slow and delayed graft function was 9.3 and 4.4%, respectively. Recipient overweight, pretransplant dialysis and warm ischemia were identified as risk factors for the occurrence of poor EGF. The rejection-free survival was worse for poor EGF as compared to immediate graft function with an adjusted hazard ratio (HR) of 6.189 (95% CI 4.075–9.399; p < 0.001). Long-term graft survival was impaired in the poor EGF group with an adjusted HR of 4.206 (95% CI 1.839–9.621; p = 0.001).

Conclusions

Poor EGF occurs in 13.7% of living donor kidney allograft recipients. Both, rejection-free and long-term graft survivals are significantly lower in patients with poor EGF as compared to patients with immediate graft function. These results underline the clinical relevance of poor EGF as phenomenon after LDKT.

Terasaki PI, Cecka JM, Gjertson DW, Takemoto S (1995) High survival rates of kidney transplants from spousal and living unrelated donors. N Eng J Med 333:333–336CrossRef

Brennan TV, Freise CE, Fuller TF, Bostrom A, Tomlanovich SJ, Feng S (2004) Early graft function after living donor kidney transplantation predicts rejection but not outcomes. Am J Transpl 4:971–979CrossRef

Nogueira JM, Harrian A, Jacobs SC, Weir MR, Hurley HA, Al-Qudah HS et al (2009) The detrimental effect of poor early graft function after laparoscopic live donor nephrectomy on graft outcomes. Am J Transpl 9:337–347CrossRef

Tyson M, Castle E, Andrews P, Heilman R, Mekeel K, Moss A, Mulligan D, Reddy K (2010) Early graft function after laparoscopically procured living donor kidney transplantation. J Urol 184:1434–1439PubMedCrossRef

Lee SY, Chung BH, Piao SG, Kang SH, Hyoung BJ, Jeon YJ et al (2010) Clinical significance of slow recovery of graft function in living donor kidney transplantation. Transplantation 90:38–43PubMedCrossRef

Osman Y, El-Husseini A, Kamal M, Refaie A, Sheashaa A, Sobh M (2011) Does timing of post-renal transplant dieresis affect graft survival in live-donor renal transplants? BJU Int 107(2):284–287PubMedCrossRef

Shoskes DA, Cecka JM (1998) Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection. Transplantation 66:1697–1701PubMedCrossRef

Troppmann C, Gillingham KJ, Benedetti E et al (1995) Delayed graft function, acute rejection, and outcome after cadaver renal transplantation. The multivariate analysis. Transplantation 59:962–968PubMedCrossRef

Ojo AO, Wolfe RA, Held PJ, Port FK, Schmouder RL (1997) Delayed graft function: risk factors and implications for renal allograft survival. Transplantation 63:968–974PubMedCrossRef

10.

Humar A, Johnson EM, Payne WD, Wrenshall L, Sutherland DE, Najarian JS et al (1997) Effect of initial slow graft function on renal allograft rejection and survival. Clin Transpl 11:623–627

11.

Kok NF, Lind MY, Hansson BM, Pilzecker D (2006) Mertens zur Borg IR, Knipscheer BC, et al. Comparison of laparoscopic and mini incision open donor nephrectomy: single blind, randomized controlled clinical trial. Br Med J 333:209–210CrossRef

12.

Dols LF, Kok NF, Terkivatan T, Tran TC, d’Ancona FC, Langenhuijsen JF et al (2010) Hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy: HARP-trial. BMC Surg 10:11PubMedCrossRef

13.

Molnar MZ, Kovesdy CP, Mucsi I, Bunnapradist S, Streja E, Krishnan M, Kalantar-Zadeh K (2011) Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int 80:218–224PubMedCrossRef

14.

Hoogeveen EK, Aalten J, Rothman KJ, Roodnat JI, Mallat MJ, Borm G, Weimar W, Hoitsma AJ, de Fijter JW (2011) Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up. Transplantation 91:869–874PubMedCrossRef

15.

Wever KE, Warlé MC, Wagener FA, van der Hoorn JW, Masereeuw R, van der Vliet JA, Rongen GA (2011) Remote ischaemic preconditioning by brief hind limb ischaemia protects against renal ischaemia-reperfusion injury: the role of adenosine. Nephrol Dial Transpl 26(10):3108–3117CrossRef

Title: Poor early graft function impairs long-term outcome in living donor kidney transplantation
Authors: J. Hellegering
J. Visser
H. J. Kloke
F. C. H. D’Ancona
A. J. Hoitsma
J. A. van der Vliet
M. C. Warlé
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 4/2013
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-012-0835-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Poor early graft function impairs long-term outcome in living donor kidney transplantation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2013

Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy

Impact of transplant nephrectomy on retransplantation: a single-center retrospective study

What is the added value of combined core biopsy and fine needle aspiration in the diagnostic process of renal tumours?

Complications of kidney transplantation with grafts from expanded criteria donors

Evaluation of sexual function in women at two stages of multiple sclerosis

Management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS): the studies, the evidence, and the impact