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Browsing by Subject "Kidney transplantation"

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  • Factors associated with long-term outcomes after delayed graft function in deceased donor kidney transplantation 
    Ahlmark, Amanda (2023)
    Background Delayed graft function (DGF) after kidney transplantation is common and is associated with worse graft outcomes and a higher risk for acute rejection. However, little is known about factors affecting graft survival post-DGF. We studied the association of cold ischemia time (CIT) and Kidney Donor Profile Index (KDPI) with the long-term outcomes of deceased brain-dead donor kidneys with and without DGF. Methods Consecutive brain-dead donor kidney transplantations performed in Finland between 5/2004-12/2019 were analyzed. Multivariable models were used to study the association of KDPI and CIT with the graft survival of kidneys with early graft function (EF) or DGF. To confirm the finding in a US cohort, data from the Scientific Registry of Transplant Recipients (SRTR) registry (n=79224) was used. Results A total of 2637 kidney transplantations from the Finnish cohort were included, of which 849 (32%) had DGF. DGF was an independent risk factor for graft loss in the multivariable model, HR 1.32 (95% CI 1.14-1.53), p < 0.001. CIT was not an independent risk factor for graft survival in the multivariable model HR 1.00 per CIT hour (95% CI 0.99-1.02), p= 0.84, and the association of DGF remained similar regardless of the CIT length. KDPI was an independent risk factor for graft survival in the multivariable model HR 1.01 (95% CI 1.01-1.01), p <0.001, but the association of DGF remained similar regardless of KDPI. In the US cohort, the results were similar, but the association of DGF with the risk of graft loss was stronger with higher KDPI. Conclusions DGF and KDPI, but not CIT, are independently associated with kidney graft survival. The magnitude of the association of DGF with worse kidney graft survival is similar with different CITs, but higher among high KDPI kidneys.
  • Is brain-dead donor fluid therapy with colloids associated with better kidney grafts? 
    Limnell, Niko (2015)
    Background: Fluid therapy is required to maintain the perfusion to donor organs. Recent reviews on the choices of fluids have emphasized the safety of using crystalloids, as opposed to fluid therapy with colloids, which has been reported either unequivocal or potentially harmful in a number of studies on various patient populations. We aimed to analyze if the type of fluids given to donors is connected with the outcome of kidney transplantation. Methods: A total of 100 consecutive brain-dead multi-organ donors and the respective 181 kidney recipients were studied retrospectively. Data concerning donor fluid therapy, the characteristics of the donors and the recipients, and the outcome after kidney transplantation were extracted from organ retrieval and patient records. Cases with early graft function (EGF) were compared to cases with delayed graft function (DGF). Results: The donor had received both crystalloids and colloids in most cases (84 %). Fluid therapy with crystalloids alone was more common among the 40 recipients with delayed graft function (30 %) than the 103 recipients with early graft function (11 %) (P=0.005). Donor age, time on dialysis before transplantation and donor fluid therapy with crystalloids alone were independent risk factors for delayed graft function in multivariate analysis. Conclusion: Our results suggest that donor fluid therapy including colloids could be beneficial instead of harmful when compared to treatment with crystalloids alone. This finding needs to be evaluated in prospective studies.

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