Has the expansion in extended criteria deceased donors led to a different type of delayed graft function and poorer outcomes?

Stevenson, R., Shapter, O., Aitken, E., Stevenson, K., Shiels, P.G. and Kingsmore, D.B. (2018) Has the expansion in extended criteria deceased donors led to a different type of delayed graft function and poorer outcomes? Transplantation Proceedings, 50(10), pp. 3160-3164. (doi: 10.1016/j.transproceed.2018.07.022) (PMID:30577182)

Abstract

Objectives: There has been considerable change in the practice of deceased kidney transplantation in the past 15 years, with more extreme phenotypes implanted. The aim of this study was to determine whether increased use of expanded criteria donors (extended criteria donors and donors after circulatory death) affected clinical outcomes, including the incidence and pattern of delayed graft function. Methods and materials: A retrospective analysis of 1359 renal transplants was performed over 15 years. The first 10 years of data (group 1) were compared with the subsequent 5 years (group 2). Outcomes were analyzed at 6 months and 12 months in addition to serum creatinine and patterns of delayed graft function (posttransplant times: on hemodialysis, to peak creatinine, for creatinine to half, and for creatinine to fall within 10% of baseline). Results: There was a significant increase in the percentage of expanded criteria donor allografts used in group 2 with a significant increase in the incidence of delayed graft function. Despite this, serum creatinine and the incidence of biopsy-proven acute rejection had both improved in group 2. Group 2 expanded criteria donor kidneys had a significantly lower incidence of type 1 delayed graft function and a significantly higher incidence of types 3 and 4 delayed graft function. Time for creatinine to half in both groups was the best predictor of a serum creatinine <180 μmol/L at 1 year. Conclusion: The increased use of expanded criteria donor kidneys has led to a higher incidence of delayed graft function, but the pattern has shown that the requirement for hemodialysis has significantly reduced.

• Item Type: Articles
• Additional Information: P. Shiels was awarded funding from GSK in 2015–2017 to investigate the molecular biology of DGF occurrence.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Shapter, Oliver and Stevenson, Dr Karen and Shiels, Professor Paul and Kingsmore, Prof David
• Authors: Stevenson, R., Shapter, O., Aitken, E., Stevenson, K., Shiels, P.G., and Kingsmore, D.B.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Transplantation Proceedings
• Publisher: Elsevier
• ISSN: 0041-1345
• ISSN (Online): 1873-2623
• Copyright Holders: Copyright © 2018 Elsevier Inc.
• First Published: First published in Transplantation Proceedings 50(10):3160-3164
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher