Journal Article

New Factors Predicting Delayed Graft Function: a Multi-Center Cohort Study of Kidney Donation After Brain Death Followed by Circulatory Death

Cai, Ruiming, Huang, Zhengyu, Zhou, Honglan, Sun, Qiquan, Sun, Qipeng, Wang, Gang, Hua, Xuefeng, Hong, Liangqing, Lin, Minzhuan, Na, Ning

2018

Overview

Background/Aims: Delayed graft function (DGF) is a common complication following kidney transplantation adversely affecting graft outcomes. Donation after brain death followed by circulatory death (DBCD), a novel donation pattern, is expected to correlate with high incidence of DGF. However, little information is available about factors associated with DGF in DBCD. Methods: A total of 383 kidney transplants from DBCD donation in three institutions were enrolled. Associations of DGF with the clinical characteristics of recipients and donors were quantified. Results: In this retrospective multi-center study, the incidence of DGF was 19.3%. Lower incidence of DGF was found in recipients for whom antithymocyte globulin was used for induction (p < 0.05), which was an independent protective factor against DGF (odds ratio [OR] = 0.48; 95% CI 0.27-0.86). Two novel explicative variables were recognized as independent risk factors, including use of vasoactive drugs (OR = 3.15; 95% CI 1.39-7.14) and cardiopulmonary resuscitation (OR = 2.51; 95% CI 1.05-6.00), which contributed significantly to increased risk of DGF (p < 0.05). Prolonged warm ischemia time (> 18 min; OR = 2.42; 95% CI 1.36-4.32), was also predictive of DGF in DBCD. A prediction model was developed and achieved an area under the curve of 0.89 in predicting DGF when combined with reported parameters. Conclusion: The novel factors, confirmed for the first time in our study, will help to improve risk prediction of DGF and to determine optimal interventions to prevent DGF in clinical practice.

• Publisher: S. Karger AG,Karger Publishers
• Subject: Adult / Antilymphocyte serum / Area Under Curve / Blood & organ donations / Brain / Brain Death / Cohort analysis / Cohort Studies / Death / Delayed graft function (DGF) / Delayed Graft Function - diagnosis / Delayed Graft Function - etiology / Donation after brain death followed by circulatory death (DBCD) / Female / Globulins / Grafting / Hospitals / Humans / Immunosuppressive agents / Incidence / Independent variables / Ischemia / Kidney transplantation / Kidney Transplantation - methods / Kidney transplants / Kidneys / Male / Middle Aged / Mortality / Original Paper / Patients / Prediction models / Prognosis / Resuscitation / Retrospective Studies / Risk analysis / Risk Factors / Shock - mortality / Thymocytes / Tissue Donors / Transplantation / Transplants / Transplants & implants / Vasoactive agents / Ventilation