Association between delayed graft function & graft loss in donation after cardiac death kidney transplants-A paired kidney registry analysis

Wai H. Lim, Stephen P.P. McDonald, Graeme R. Russ, Jeremy R. Chapman, Maggie KM Ma, Henry Pleass, Bryon Jaques, Germaine Wong

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21 Citations (Scopus)

Abstract

Background.Delayed graft function (DGF) is an established complication after donation after cardiac death (DCD) kidney transplants, but the impact of DGF on graft outcomes is uncertain. Tominimize donor variability and bias, a paired donor kidney analysis was undertaken where 1 kidney developed DGF and the other did not develop DGF using data from the Australia and New Zealand Dialysis and Transplant Registry.Methods. Using paired DCD kidney data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the association between DGF, graft and patient outcomes between 1994 and 2012 using adjusted Cox regressionmodels. Results. Of the 74 pairs of DCD kidneys followed for a median of 1.9 years (408 person-years), a greater proportion of recipients with DGF had experienced overall graft loss and death-censored graft loss at 3 years compared with those without DGF (14% vs 4%, P=0.04 and11%vs0%, P < 0.01, respectively). Compared with recipients without DGF, the adjusted hazard ratio for overall graft loss at 3 years for recipients with DGF was 4.31 (95%confidence interval [95% CI], 1.13-16.44). The adjusted hazard ratio for acute rejection and all-cause mortality at 3 years in recipients who have experienced DGF were 0.98 (95% CI, 0.96-1.01) and 1.70 (95% CI, 0.36-7.93), respectively, compared with recipients without DGF. Conclusions. Recipients of DCD kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. Strategies aim to reduce the risk of DGF could potentially improve graft survival in DCD kidney transplants. Copyright © 2017 Wolters Kluwer Health, Inc. 

Original languageEnglish
Pages (from-to)1139-1143
Number of pages5
JournalTransplantation
Volume101
Issue number6
DOIs
Publication statusPublished - Jun 2017

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Delayed Graft Function
Registries
Transplants
Kidney
Confidence Intervals
New Zealand
Dialysis
Tissue Donors
Graft Survival

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Lim, Wai H. ; McDonald, Stephen P.P. ; Russ, Graeme R. ; Chapman, Jeremy R. ; Ma, Maggie KM ; Pleass, Henry ; Jaques, Bryon ; Wong, Germaine. / Association between delayed graft function & graft loss in donation after cardiac death kidney transplants-A paired kidney registry analysis. In: Transplantation. 2017 ; Vol. 101, No. 6. pp. 1139-1143.
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abstract = "Background.Delayed graft function (DGF) is an established complication after donation after cardiac death (DCD) kidney transplants, but the impact of DGF on graft outcomes is uncertain. Tominimize donor variability and bias, a paired donor kidney analysis was undertaken where 1 kidney developed DGF and the other did not develop DGF using data from the Australia and New Zealand Dialysis and Transplant Registry.Methods. Using paired DCD kidney data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the association between DGF, graft and patient outcomes between 1994 and 2012 using adjusted Cox regressionmodels. Results. Of the 74 pairs of DCD kidneys followed for a median of 1.9 years (408 person-years), a greater proportion of recipients with DGF had experienced overall graft loss and death-censored graft loss at 3 years compared with those without DGF (14{\%} vs 4{\%}, P=0.04 and11{\%}vs0{\%}, P < 0.01, respectively). Compared with recipients without DGF, the adjusted hazard ratio for overall graft loss at 3 years for recipients with DGF was 4.31 (95{\%}confidence interval [95{\%} CI], 1.13-16.44). The adjusted hazard ratio for acute rejection and all-cause mortality at 3 years in recipients who have experienced DGF were 0.98 (95{\%} CI, 0.96-1.01) and 1.70 (95{\%} CI, 0.36-7.93), respectively, compared with recipients without DGF. Conclusions. Recipients of DCD kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. Strategies aim to reduce the risk of DGF could potentially improve graft survival in DCD kidney transplants. Copyright {\circledC} 2017 Wolters Kluwer Health, Inc. ",
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Association between delayed graft function & graft loss in donation after cardiac death kidney transplants-A paired kidney registry analysis. / Lim, Wai H.; McDonald, Stephen P.P.; Russ, Graeme R.; Chapman, Jeremy R.; Ma, Maggie KM; Pleass, Henry; Jaques, Bryon; Wong, Germaine.

In: Transplantation, Vol. 101, No. 6, 06.2017, p. 1139-1143.

Research output: Contribution to journalArticle

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T1 - Association between delayed graft function & graft loss in donation after cardiac death kidney transplants-A paired kidney registry analysis

AU - Lim, Wai H.

AU - McDonald, Stephen P.P.

AU - Russ, Graeme R.

AU - Chapman, Jeremy R.

AU - Ma, Maggie KM

AU - Pleass, Henry

AU - Jaques, Bryon

AU - Wong, Germaine

PY - 2017/6

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N2 - Background.Delayed graft function (DGF) is an established complication after donation after cardiac death (DCD) kidney transplants, but the impact of DGF on graft outcomes is uncertain. Tominimize donor variability and bias, a paired donor kidney analysis was undertaken where 1 kidney developed DGF and the other did not develop DGF using data from the Australia and New Zealand Dialysis and Transplant Registry.Methods. Using paired DCD kidney data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the association between DGF, graft and patient outcomes between 1994 and 2012 using adjusted Cox regressionmodels. Results. Of the 74 pairs of DCD kidneys followed for a median of 1.9 years (408 person-years), a greater proportion of recipients with DGF had experienced overall graft loss and death-censored graft loss at 3 years compared with those without DGF (14% vs 4%, P=0.04 and11%vs0%, P < 0.01, respectively). Compared with recipients without DGF, the adjusted hazard ratio for overall graft loss at 3 years for recipients with DGF was 4.31 (95%confidence interval [95% CI], 1.13-16.44). The adjusted hazard ratio for acute rejection and all-cause mortality at 3 years in recipients who have experienced DGF were 0.98 (95% CI, 0.96-1.01) and 1.70 (95% CI, 0.36-7.93), respectively, compared with recipients without DGF. Conclusions. Recipients of DCD kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. Strategies aim to reduce the risk of DGF could potentially improve graft survival in DCD kidney transplants. Copyright © 2017 Wolters Kluwer Health, Inc. 

AB - Background.Delayed graft function (DGF) is an established complication after donation after cardiac death (DCD) kidney transplants, but the impact of DGF on graft outcomes is uncertain. Tominimize donor variability and bias, a paired donor kidney analysis was undertaken where 1 kidney developed DGF and the other did not develop DGF using data from the Australia and New Zealand Dialysis and Transplant Registry.Methods. Using paired DCD kidney data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the association between DGF, graft and patient outcomes between 1994 and 2012 using adjusted Cox regressionmodels. Results. Of the 74 pairs of DCD kidneys followed for a median of 1.9 years (408 person-years), a greater proportion of recipients with DGF had experienced overall graft loss and death-censored graft loss at 3 years compared with those without DGF (14% vs 4%, P=0.04 and11%vs0%, P < 0.01, respectively). Compared with recipients without DGF, the adjusted hazard ratio for overall graft loss at 3 years for recipients with DGF was 4.31 (95%confidence interval [95% CI], 1.13-16.44). The adjusted hazard ratio for acute rejection and all-cause mortality at 3 years in recipients who have experienced DGF were 0.98 (95% CI, 0.96-1.01) and 1.70 (95% CI, 0.36-7.93), respectively, compared with recipients without DGF. Conclusions. Recipients of DCD kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. Strategies aim to reduce the risk of DGF could potentially improve graft survival in DCD kidney transplants. Copyright © 2017 Wolters Kluwer Health, Inc. 

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DO - 10.1097/TP.0000000000001323

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JF - Transplantation

SN - 0041-1337

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