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Delayed Graft Function

Delayed Graft Function (DGF) is a common complication in solid organ transplantation, particularly in kidney transplantation.
DGF is defined as the need for dialysis in the first week after transplantation, and can have significant impact on graft and patient outcomes.
Understanding the factors that contribute to DGF and developing effective strategies to prevent and manage it is crucial for improving transplant success.
This MeSH term provides a comprehensive overview of the current knowledge and research on DGF, covering its epidemiology, risk factors, pathophysiology, and clinical management.
Researchers and clinicians can leverage this information to enhance their studies and optimize patient care in the field of transplantation.

Most cited protocols related to «Delayed Graft Function»

1
Kidney and SPK Transplant Outcomes
Between, 10/03/2005 and 4/10/2008, 990 kidney and SPK recipients at 6 transplant centers (Table 1) were enrolled in a prospective study of kidney allograft function. Patients were consented for participation at the time of or soon after transplantation. All kidney transplant recipients undergoing a kidney or SPK transplant were eligible. Patients with non-kidney solid organ transplants were not eligible. The Institutional Review Boards at each of the study sites approved this study.
Immunosuppression and AR treatment was center-specific. Clinical data were collected at the time of transplant and regularly until allograft failure and maintained in a central database. Delayed graft function was defined as need for dialysis in the first week post-transplantation. AR was defined by the treating physician. Local pathologist reading of biopsies was collected for all biopsies done for cause.
Israni A., Leduc R., Holmes J., Jacobson P.A., Lamba V., Guan W., Schladt D., Chen J., Matas A.J, & Oetting W.S. (2010). Single Nucleotide Polymorphisms, Acute Rejection and Severity of Tubulitis in Kidney Transplantation, Accounting for Center-to-Center Variation. Transplantation, 90(12), 1401-1408.
Publication 2010
Allografts Biopsy Delayed Graft Function Dialysis Ethics Committees, Research Grafts Immunosuppression Kidney Kidney Function Tests Kidney Transplantation Pathologists Patients Physicians Transplantation Transplant Recipients
2
Retrospective Analysis of dnDSA in Kidney Transplant
For this retrospective analysis, we included all kidney transplant recipients with dnDSA from 01/03/2000 until 31/05/2021 (end of follow-up) at Charité-Universitätsmedizin Berlin (Germany). All patients with dnDSA against the last graft with complete HLA typing were included, excluding those patients with preformed DSA before transplantation. The primary outcome variable in our study was time to death-censored graft failure, defined as graft loss (i.e., the need for permanent dialysis, allograft nephrectomy, or re-transplantation). Patients who developed dnDSA after graft loss were excluded.
All data including estimated glomerular filtration rate (GFR, ml/min), proteinuria (mg/g creatinine), delayed graft function (DGF), defined as the need for dialysis within 7 days of transplant, and biopsy data were collected from the prospectively maintained database (TBase) (49 (link)). All rejections were categorized according to Banff 2017 classification (5 (link), 50 (link), 51 (link)). Calculated panel-reactive antibody (cPRA) was obtained through the Virtual PRA Calculator of the Eurotransplant Reference Laboratory.1 No institutional review board approval was required for this retrospective analysis.
López del Moral C., Wu K., Naik M., Osmanodja B., Akifova A., Lachmann N., Stauch D., Hergovits S., Choi M., Bachmann F., Halleck F., Schrezenmeier E., Schmidt D, & Budde K. (2022). The natural history of de novo donor-specific HLA antibodies after kidney transplantation. Frontiers in Medicine, 9, 943502.
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Publication 2022
Allografts Biopsy Creatinine Delayed Graft Function Dialysis Ethics Committees, Research Grafts Immunoglobulins Kidney Transplantation Nephrectomy Patients Transplantation
3
Clinical Outcomes in Kidney Transplant Recipients
We investigated clinical outcome factors including estimated glomerular filtration rate (eGFR), biopsy-proven acute rejection (BPAR) rate, graft survival, and patient survival. In addition, cause of death, incidence of infectious disease, and risk factors for graft failure were evaluated. eGFR was measured at two weeks, and one, two, three, four, and five years after transplant, as calculated using the Chronic Kidney Disease Epidemiology Collaboration equation [13 (link)]. BPAR was diagnosed based on the Banff classification [14 (link)], and was subdivided according to the time of diagnosis (early: one year or less after transplant, and late: more than one year after transplant), and type of rejection (acute T-cell mediated rejection [TCMR] and active ABMR). Graft survival was defined as the time from KT to re-start of the renal replacement therapy. In the case of the patient death with a functioning graft, the patient’s graft survival was censored at the time of death. Patient survival was defined as the time from KT to death from any cause. The clinical outcome results of each incompatible KT were compared to those from non-sensitized KT.
We defined delayed graft function in individuals who needed dialysis during the first week after KT because of poor graft function [15 (link)]. Cytomegalovirus (CMV) infection was defined in KTRs who had CMV antigenemia or who were positive for CMV polymerase chain reaction, and were also treated for CMV. BK virus nephropathy was defined as KTRs who had more than 10,000 copies/mL of BK virus DNA in serum and were treated for BK virus, or in whom BK virus nephropathy was diagnosed by graft biopsy [16 (link)].
Lim J.H., Cho J.H., Jung H.Y., Choi J.Y., Park S.H., Kim Y.L., Kim H.K., Huh S., Yoo E.S., Won D.I, & Kim C.D. (2019). Excellent outcome after desensitization in high immunologic risk kidney transplantation. PLoS ONE, 14(9), e0222537.
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Publication 2019
Biopsy BK Virus Chronic Kidney Diseases Communicable Diseases Cytomegalovirus Cytomegalovirus Infections Delayed Graft Function Dialysis DNA Viruses Glomerular Filtration Rate Grafts Graft Survival Kidney Diseases Patients Polymerase Chain Reaction Renal Replacement Therapy Serum T-Lymphocyte
4
Donor-Derived Cell-Free DNA in Kidney Transplant Rejection
We performed a retrospective review of all KTR who underwent dd-cfDNA testing (Chronix Biomedical, Göttingen, Germany) for clinical care between April 2020 and April 2021 at our institution. Indications for dd-cfDNA testing were previously diagnosed or suspected rejection, otherwise worsening kidney function, or a change of immunosuppressive regimen, among others. For patients with worsening kidney function or suspected rejection, measurements were performed at least once, and follow-up measurements were performed as indicated by the treating clinician. For patients who underwent a change of immunosuppressive regimen, measurements were performed 4 times (baseline and after 1, 3, and 6 mo). An abnormal dd-cfDNA result was defined as a value of >0.5% or >50 copies/mL, respectively.10 (link) All patients with at least 1 test showing a discrepancy between the relative and absolute quantifications of dd-cfDNA were included in the case series.
Donor characteristics evaluated included age, sex, and living versus deceased donation. Recipient characteristics evaluated included age, sex, cause of chronic kidney failure, type of dialysis, duration of dialysis, induction immunosuppressive regimen, early graft function, and time since transplantation. Delayed graft function was defined as the need for dialysis within 7 d after transplantation. Recipient serum creatinine, microalbuminuria, kidney biopsy results, dd-cfDNA levels, presence of donor-specific anti-HLA antibodies (DSA), and major clinical events after transplantation were examined and included in a comprehensive graphical case description for each patient. For illustration, red-shaded areas representing absolute dd-cfDNA and red lines representing relative dd-cfDNA were included in the graphs. Absolute and relative dd-cfDNA and total cfDNA, as well as the corresponding reference ranges, are provided in Table S1 (SDC, http://links.lww.com/TXD/A375).
The measurement of dd-cfDNA was performed as described previously.10 (link),14 (link) In brief, for each patient, 4 informative single nucleotide polymorphisms (SNPs), defined as an SNP for which the recipient has a homozygous allelic state and the graft carries at least 1 heterozygous allele, were selected from a predefined set of 40 SNPs. These 4 SNPs were used to quantify the dd-cfDNA (%) concentration, defined as donor alleles/(donor alleles + recipient alleles). Results for SNPs with heterozygous graft genotypes were corrected by a factor 2. Total cfDNA was extracted from up to 8 mL of plasma collected in certified blood collection tubes (Streck Corp, Omaha, Nebraska). The concentration was determined using droplet-digital PCR and was corrected for extraction loss and cfDNA fragmentation, as described previously.10 (link) The absolute concentration of dd-cfDNA per mL of plasma was calculated by multiplying total cfDNA (copies/mL) and dd-cfDNA (%). Reference ranges for total cfDNA in the posttransplant course were assessed in a cohort of 300 KTR, as described previously.13 (link)The institutional review board of the ethics committee of Charité-Universitätsmedizin Berlin, Germany, approved the study (approval number EA2/144/20), and all procedures were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all patients.
Osmanodja B., Akifova A., Budde K., Choi M., Oellerich M., Schütz E, & Beck J. (2021). Absolute or Relative Quantification of Donor-derived Cell-free DNA in Kidney Transplant Recipients: Case Series. Transplantation Direct, 7(11), e778.
Publication 2021
Alleles Anti-Antibodies Biopsy BLOOD Cell-Free DNA Creatinine Delayed Graft Function Dialysis Donors Ethics Committees Ethics Committees, Research factor A Fingers Genotype Grafts Heterozygote Homozygote Immunosuppressive Agents Kidney Kidney Failure, Chronic MLL protein, human Patients Plasma Serum Single Nucleotide Polymorphism Transplantation Treatment Protocols
5
Definitions of Graft Survival and Rejection in Kidney-Pancreas Transplantation
According to previous definitions, we defined overall kidney graft survival from date of transplantation until patient death, kidney re-transplantation, need for dialysis or loss of follow-up [9 (link)]. Accordingly, overall pancreas graft survival was defined as pancreas failure with resumed insulin therapy, patient death or loss of follow-up. We defined overall patient survival from date of transplantation until patient death or loss of follow-up [9 (link)].
Delayed graft function (DGF) of the pancreas was defined as the need for insulin substitution at the time of hospital care but without further need after the discharge.
The definition of delayed graft function (DGF) of the kidney is based on range of clinical criteria and there are more than 10 definitions reported in the literature [27 (link)–30 (link)].
Despite shortfalls, in our study, DGF of the kidney was defined as the need for dialysis at hospital time but without further need after discharge, since it offers the most used standard, by which transplant centers pragmatically report outcomes and which furthermore makes a comparison of published studies on this topic possible.
Acute rejection of the pancreas allograft was defined by an increase of serum lipase and/or amylase, elevated fasting plasma glucose levels, a need for exogenous insulin, a low C-peptide level, an impaired renal function with elevated serum creatinine levels, clinical symptoms (pain, fever, leukocytosis) and/or confirmed by renal histology.
Kidney biopsy was performed when acute rejection of the transplant kidney was clinically suspected. Routine pancreas biopsies were not routinely performed. Rejection episodes were treated with 500 mg of methylprednisolone over three to five days or if steroid-resistant with ATG.
Hau H.M., Jahn N., Brunotte M., Lederer A.A., Sucher E., Rasche F.M., Seehofer D, & Sucher R. (2020). Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft. BMC Endocrine Disorders, 20, 30.
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Publication 2020
Allografts Amylase Biopsy C-Peptide Creatinine Delayed Graft Function Dialysis Fever Glucose Grafts Graft Survival Insulin Kidney Kidney Transplantation Leukocytosis Lipase Methylprednisolone Pain Pancreas Pancreas Transplantation Patient Discharge Patients Plasma Renal Insufficiency Serum Steroids Therapeutics Transplantation

Most recents protocols related to «Delayed Graft Function»

1
Retrospective Cohort Study of Kidney Transplant
We performed a retrospective cohort study using the University of Montreal Renal Transplant Biobank. From 1st July 2008 to 31st December 2016, consecutive patients undergoing kidney transplantation at two Canadian, university-affiliated hospitals were entered into a clinical and biological database after providing written informed consent. ABO-incompatible transplantations and transplantations crossing pre-transplant DSA are not performed in either center. Serum samples from participants were collected immediately prior to transplantation and banked at −80°C for subsequent analyses. Clinical information was collected prospectively and supplemented retrospectively by chart review as needed. If a patient had more than one kidney transplantation recorded in the database, only the most recent transplant was included. Patients with past or simultaneous non-renal solid organ transplants were excluded. All patients included in the present study were different from those included in our previous publication on rejection (17 (link)), and 172 patients were included in our previous work on delayed graft function (10 (link)). The project was approved by the local ethics review board of the Centre Hospitalier de l’Université de Montréal (project numbers 14.169 and 16.204).
Mawad H., Pinard L., Medani S., Chagnon M., Boucquemont J., Turgeon J., Dieudé M., Hamelin K., Rimbaud A.K., Belayachi A., Yang B., Collette S., Sénécal L., Foster B.J., Hébert M.J, & Cardinal H. (2023). Hypothermic Perfusion Modifies the Association Between Anti-LG3 Antibodies and Delayed Graft Function in Kidney Recipients. Transplant International, 36, 10749.
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Publication 2023
Biopharmaceuticals Delayed Graft Function Grafts Incompatibility, ABO Kidney Transplantation Patients Serum Transplantation
2
Composite Efficacy Endpoints in Kidney Transplant
The primary efficacy end point was a composite of BPAR, de novo donor-specific antibody formation, and graft failure at 12 months after kidney transplantation. BPAR was determined by pathological evidence interpreted by the Banff criteria [20 (link)–23 (link)]. Delayed graft function was defined as the need for dialysis during the first week after transplantation, excluding a single session for the treatment of hyperkalemia. Kidney graft failure was defined as the need for a transplant nephrectomy, retransplant, or recommencement of dialysis. The secondary efficacy end point was renal function determined by eGFR (CKD-EPI) at one and six months post-transplant and one and two years post-transplant. The safety end points included infection, leukopenia, thrombocytopenia, and malignancy. Leukopenia was defined as a white cell count of less than 2500 per cubic millimeter. Thrombocytopenia was defined as a platelet count of less than 80,000 per cubic millimeter.
Ko Y., Wee Y.M., Shin S., Kim M.J., Choi M.Y., Kim D.H., Lim S.J., Jung J.H., Kwon H., Kim Y.H, & Han D.J. (2023). A prospective, randomized, non-blinded, non-inferiority pilot study to assess the effect of low-dose anti-thymocyte globulin with low-dose tacrolimus and early steroid withdrawal on clinical outcomes in non-sensitized living-donor kidney recipients. PLOS ONE, 18(3), e0280924.
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Publication 2023
Antibody Formation Cuboid Bone Delayed Graft Function Dialysis Donors EGFR protein, human Grafts Infection Kidney Kidney Failure Kidney Transplantation Leukocyte Count Leukopenia Malignant Neoplasms Nephrectomy Platelet Counts, Blood Safety Thrombocytopenia Transplantation
3
Comprehensive Monitoring of Kidney Transplant Outcomes
Postoperatively, patients were monitored for clinical (blood pressure, urine output), biological (ionic balance, serum creatinine), and sonographic signs of complications at defined time points. Graft function was initially evaluated by urine production within the first 24 h after transplantation and by serum creatinine levels at defined time points.
The presence of delayed graft function (DGF) was defined as the need for dialysis within the first week after surgery and/or failure of creatinine clearance to rise above 10 mL/min within the first 5 postoperative days irrespective of dialysis need, acute rejection, and immunosuppressant regimen at discharge.
Any complication or need for intervention following surgery was noted. Postoperative complications were rated according to the Clavien-Dindo classification [12 (link)].
Follow-up data were collected by our transplant program in cooperation with the Department of Nephrology of the University of Essen, Germany. Initially, patients were evaluated every 2 weeks until 3 months and every month thereafter until 6 months. After 6 months, the follow-up examination carried out every 3 months.
Cyrek A.E., Flögel L., Pacha A., Kaths M., Treckmann J., Paul A, & Schulze M. (2023). Kidney transplantation following iliac revascularization in severe atherosclerosis: a comparative study. Langenbeck's Archives of Surgery, 408(1), 105.
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Publication 2023
Biopharmaceuticals Blood Pressure Creatinine Delayed Graft Function Dialysis Grafts Immunosuppressive Agents Ions Operative Surgical Procedures Patient Discharge Patients Postoperative Complications Serum Transplantation Treatment Protocols Ultrasonography Urine
4
Graft Weight and Kidney Transplant Outcomes
This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the local ethics committee (Approval no: 2023-01-30).
The data of patients who underwent KTx at our center between January 2018 and December 2022 were retrospectively reviewed. After excluding patients whose archival records could not be accessed, patients who developed acute rejection in the early period, and patients receiving cadaveric transplants, a total of 215 KTx cases (215 donors, 215 recipients) were included in the study. Cadaveric kidney transplants were excluded because all pertinent parameters were not evaluated in those cases. Furthermore, the delayed graft function rate - observed at a higher probability in cadaveric transplants compared to living transplants - could have caused interpretation errors in the statistical analyses.
Patients' age, sex, BMI, preoperative donor serum cystatin C and e-GFR levels, HLA tissue compatibility, graft weights, and recipient creatinine levels were recorded one week postoperatively. Graft weights were acquired from data recorded by weighing the graft kidney after removing perinephric adipose tissue following bench surgery. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was used to calculate e-GFR. The effect of graft weight on postoperative graft function was evaluated by calculating the graft weight (g)/recipient BMI (kg/m2) (G/B) ratio. HLA tissue compatibility was statistically analyzed by examining the number of matches in the three HLA pairs (A, B, DR).
All patients were operated on by the same surgical team using the same surgical technique. In the postoperative period, all patients received the routine immunosuppressive treatment regimen administered at our center. Induction and maintenance of the immunosuppression treatment were performed in all patients; this treatment comprised antithymocyte globulin (ATG, 3 mg/kg, three days), tacrolimus (FK506, 1 mg/kg), mycophenolate mofetil (2 × 1000 mg), and prednisolone. The doses were adjusted for a target blood level of 10 mg/ml for FK506 and a target CD3 count of 20-50 for ATG.
Statistical analyses were performed using the IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY). The Kolmogorov-Smirnov test and histogram plots were used to analyze the conformity of the variables to normal distribution. Mean, standard deviation (SD), and median (min-max) values were used when presenting descriptive analyses. Spearman's correlation test was used to analyze the relationship between variables. P-values below 0.05 indicate statistical significance.
Açıkgöz O, & Akıncı S. (2023). The Predictive Value of Donor Renal Functions, Graft Weight, Recipient Body Mass Index, and Human Leucocyte Antigen Match Regarding Early Graft Functions. Cureus, 15(2), e35438.
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Publication 2023
A 215 BLOOD Creatinine Delayed Graft Function Donors FK-506 Grafts Immunosuppression Immunosuppressive Agents Kidney Transplantation Lymphocyte Immune Globulin, Anti-Thymocyte Globulin Mycophenolate Mofetil Operative Surgical Procedures Patients Post-gamma-Globulin Prednisolone Regional Ethics Committees Serum Tacrolimus Tissue, Adipose Treatment Protocols
5
Retrospective Analysis of Kidney Transplant Outcomes
This retrospective analysis was approved by the local ethics committee of the Justus-Liebig-University Giessen, Germany (institutional review board no. AZ 123/18). A total of 116 consecutive patients who had undergone KT between 2013 and 2017 were analyzed and were followed up to December 31, 2021. The collected data included the following demographic characteristics: age, sex, body mass index (BMI), underlying kidney disease, duration of dialysis, warm and cold ischemia times, intra- and postoperative course, delayed graft function, graft failure, rejection rate, surgical complications, and overall patient and graft survival data. Comorbidities were classified and analyzed by the Charlson comorbidity index [21 (link)].
Renal function was assessed using serum creatinine levels and estimated glomerular filtration rate (eGFR) according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula at 1, 2, 3, 4, and 5 years after KT. Delayed graft function (DGF) was defined as the need for at least one dialysis within the first 7 days following KT [22 (link)].
Complications in the first 30 days after KT were classified according to the Clavien-Dindo classification [23 (link)]. The Clavien-Dindo ≥ 3a were defined as severe and included in the statistical analysis.
Karakizlis H., Trudel N., Brose A., Reinisch A., Reichert M., Hecker A., Bender F., Askevold I., Rainer L., Weimer R., Krombach G.A., Padberg W, & Liese J. (2023). Sarcopenia of kidney transplant recipients as a predictive marker for reduced graft function and graft survival after kidney transplantation. Langenbeck's Archives of Surgery, 408(1), 103.
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Publication 2023
Creatinine Delayed Graft Function Dialysis Ethics Committees, Research Glomerular Filtration Rate Grafts Graft Survival Index, Body Mass Kidney Kidney Diseases Operative Surgical Procedures Patients Regional Ethics Committees Serum

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1
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More about "Delayed Graft Function"

Delayed Graft Dysfunction (DGD), Ischemia-Reperfusion Injury (IRI), Kidney Transplantation, Solid Organ Transplantation, Graft Survival, Allograft Rejection, Immunosuppression, Biomarkers, Prognosis, Personalized Medicine Delayed Graft Function (DGF), also known as Delayed Graft Dysfunction, is a common and serious complication that can occur after solid organ transplantation, particularly in kidney transplants.
DGF is defined as the need for dialysis within the first week following transplantation, and it can have a significant impact on graft and patient outcomes.
Understanding the underlying factors that contribute to DGF is crucial for improving transplant success.
Risk factors for DGF include prolonged cold ischemia time, donor age, and pre-existing conditions in the recipient, such as diabetes and hypertension.
The pathophysiology of DGF involves complex mechanisms, including ischemia-reperfusion injury (IRI), which can lead to inflammation, oxidative stress, and cell death.
Researchers and clinicians can leverage advanced tools and technologies to better understand and manage DGF.
For example, the Prism software and GraphPad Prism 5 can be used for statistical analysis and data visualization, while the Architect analyzer and SPSS v20 can aid in biomarker assessment and risk stratification.
Additionally, the ImmPRESS polymer staining kit and LSM 710 confocal microscope can be utilized for in-depth histological and molecular analyses.
Emerging therapies, such as the use of Thymoglobuline and Simulect, aim to modulate the immune response and mitigate the impact of DGF.
Ongoing research and clinical trials are exploring novel biomarkers, personalized treatment approaches, and innovative strategies to prevent and manage this critical complication in solid organ transplantation.
By incorporating these insights and leveraging the latest tools and technologies, researchers and clinicians can enhance their understanding of DGF, optimize patient care, and ultimately improve transplant outcomes.