Abstract: TH-PO1128
Risk Factors, Prediction, and Outcomes of Delayed Graft Function (DGF): An Analysis from a German Cohort of Extended Criteria Donor Kidneys with Post-Explantation Biopsies
Session Information
- Transplantation: Clinical - Predictors of Outcomes - Biomarkers and Beyond
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Scurt, Florian Gunnar, Otto von Guericke University Magdeburg - Medical Faculty, Magdeburg, SH, Germany
- Mertens, Peter R., Otto von Guericke University Magdeburg - Medical Faculty, Magdeburg, SH, Germany
- Haller, Hermann G., Hannover Medical School, Hannover, Germany
- Becker, Jan U., University Hospital Cologne, Köln, NW, Germany
- Chatzikyrkou, Christos D., Otto von Guericke University Magdeburg - Medical Faculty, Magdeburg, SH, Germany
Background
DGF occurs frequently after transplantation and is associated with worse short- and long-term outcomes and associated with higher rejection rates. Risk factors include both donor and recipient characteristics, although their prediction is imprecise. Therefore, we tested known risk factors of DGF and validated the performance of existing risk scores in predicting DGF in recipients of extended criteria donor kidneys with procurement biopsies.
Methods
We retrospectively evaluated the records of 223 consecutive adult cadaver renal transplant recipients with donor evaluation biopsies. 135 patients developed DGF (defined as the need for hemodialysis during the first week after transplantation). Clinical donor and recipient characteristics as well as histological features of the biopsy were compared between the two groups and the following risk scores were evaluated regarding their association with observed DGF: Navarro (2011), Ortiz (2004), Balaz (2013), Lopes (2004), Snoeijs (2008), Remuzzi (1999), Nyberg (2003), Rao (2009), Foucher (2009), Schold (2005), Port (2002), Anglicheau (2008), Leuven (2013) Irish (2010), KDRI/KDPI and EPTS.
Results
Severity of acute kidney injury (similar to AKIN Classification) at ICU stay, last creatinine, proteinuria, macroscopic organ quality, microthrombi by histology, prolonged warm ischemia time, recipient body mass index, and recipient duration of dialysis were significant risk factors for the development of DGF in the recipient in univariable analysis. None of the evaluated scores could accurately predict DGF. In multivariable analysis only severity of acute kidney injury and microthrombi by biopsy remained statistically significant (OR 1.89 95%CI 1.26-2.84, p=0.002; OR 3.06, 95%CI 1.00-9.34, p=0.049, respectively).
Conclusion
None of the established clinical, histological or combined scores for quality assessment of deceased donor kidneys appeared sufficiently prognostic for DGF in our cohort. We are currently working on a novel combined clinicopathological score better suited for clinical application in the Eurotransplant network.