The donor factors related with delayed graft function after deceased donor kidney transplantation
Woo Yeong Park1, Ohyun Kwon1, Yaerim Kim1, Jin Hyuk Paek1, Kyubok Jin1, Young-Nam Roh2, Ui Jun Park2, Hyoung Tae Kim2, Seungyeup Han1.
1Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Keimyung University Kidney Institute, Daegu, Korea; 2Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University School of Medicine, Keimyung University Kidney Institute, Daegu, Korea
Background: The factors related to the deceased donor (DD) influences absolutely the outcomes of deceased donor kidney transplantation (DDKT). Therefore, there are several tools for evaluation of the status of DD such as expanded criteria donor or kidney donor profile index, but the donor factors for prediction the outcome are uncertain. We investigate the DD factors related with the occurrence of DGF in DDKT.
Methods: We retrospectively analyzed the medical records of DDKT performed at Dongsan Medical Center between February 2014 and September 2019. Our study enrolled 186 kidney transplant recipients (KTRs), with median follow-up of 45 months after DDKT.
Results: In our study, 87 DDs (46.5%) had a documented history of smoking; 108 (57.8%), proteinuria; 80 (42.8%), transfusion; 95 (50.8%), acute kidney injury (AKI); and continuous renal replacement therapy, 18 (9.6%). The incidence of DGF was significantly higher in KTRs from DDs with CRRT compared to those from DDs without CRRT (P=0.002). The incidence of DGF was also higher in KTRs from DDs with smoking history, but there were no significant association with the presence and amount of proteinuria and transfusion. Allograft function was significantly lower in the KTRs with DGF until 1 month after KT compared to those without DGF, but there was no significant difference of allograft function between the two groups at 12 months after KT. In Kaplan Meier analysis, allograft survival and patient survivals did not show the differences according to the characteristics of donor with smoking, proteinuria, transfusion, AKI, and CRRT. Multivariate logistic analysis showed that, after accounting for confounding factors, the effects of CRRT, AKI, donor hypertension, and smoking were independent risk factors for DGF (hazard ratio (HR) 14.62, 95% C.I. 2.39-89.57, P=0.004; HR 4.62, 95% C.I. 1.80-11.83, P=0.001; HR 3.81, 95% C.I. 1.26-11.53, P=0.018; HR 2.65, 95% C.I. 1.07-6.61, P=0.036, respectively).
Conclusions: This study suggests that deceased donor kidneys with CRRT, AKI, donor hypertension, and smoking contribute to an increased risk of development of DGF for kidney allograft recipients. In particular, the risk of developing DGF increases when several factors are present together. Therefore, KT from DDs with significant risk factors should be performed carefully.
This study was supported by the First Research Support Project of the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT in 2018 (NRF-2017R1C1B5076739)..
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