Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation
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RESEARCH ARTICLE
Open Access
Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation Rao Chen1,2, Haifeng Wang1,2, Lei Song1,2, Jianfei Hou1,2, Jiawei Peng1,2, Helong Dai1,2,3* and Longkai Peng1,2*
Abstract Background: Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. Methods: This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. Results: The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). Conclusion: The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival. Keywords: Delayed graft function, Predictors, Nomogram, Deceased donation, Graft survival
Background Kidney transplantation has been successful and has saved numerous lives since the 1960s. Compared to regular kidney dialysis, kidney transplantation results in better patient quality of life and longer survival [1]. Deceased donation (DD), including donation after brain death (DBD), donation after cardiac death (DCD), and donation after brain death awaiting cardiac death (DBCD), has been promoted in recent years throughout China, allowing an increasing numbers of patients to * Correspondence: [email protected]; [email protected] 1 Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China Full list of author information is available at the end of the article
recover from uremia. However, DGF is one of the most common postoperative complications [2, 3], the incidence of which varies from 5 to 50% in DD kidney transplantation. There is a scarcity of donated kidneys, and the use of marginal kidneys has dramatically increased the incidence of DGF, which is not only a risk factor for acute rejection but is also associated with poor longterm survival of the graft [4, 5]. Some centers believe that DGF in transplantation is a specific manifestation of acute tubular necrosis (ATN) during the procedure [6]. In general, renal graft functi
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