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Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors.

PLoS One 2021 5;16(4):e0249552. Epub 2021 Apr 5.

Renal Transplant Center "A. Vercellone," Nephrology, Dialysis, and Renal Transplant Division, Department of Medical Sciences, "AOU Città Della Salute e Della Scienza di Torino" University Hospital, University of Turin, Turin, Italy.

Background: Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive.

Methods: A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003-2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). Read More

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Impact of deceased donor with acute kidney injury on subsequent kidney transplant outcomes-an ANZDATA registry analysis.

PLoS One 2021 25;16(3):e0249000. Epub 2021 Mar 25.

Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.

Background: The need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature.

Material And Methods: This observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. Read More

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The Relationship Between Pre-Transplant Serum Phosphorus Before Kidney Transplantation with Early Graft Dysfunction.

Iran J Kidney Dis 2021 Mar;1(2):148-154

1Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Introduction: Pre-transplant serum phosphorus level is shown to be associated with some transplant outcomes in patients with chronic kidney disease. However, its association with Delayed graft function (DGF) has an aura of ambiguity. DGF means either the patient needs dialysis during the first week after transplantation or the creatinine level is ≥ 3. Read More

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Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the UK: a national cohort study.

Am J Transplant 2021 Mar 23. Epub 2021 Mar 23.

Department of Nephrology and Transplantation, NHS Foundation Trust, Guy's and St Thomas, London, UK.

Kidneys from donation after circulatory death (DCD) donors are utilized variably worldwide, in part due to high rates of delayed graft function (DGF) and putative associations with adverse longer-term outcomes. We aimed to determine whether the presence of DGF, and its duration, were associated with poor longer-term outcomes after kidney transplantation from DCD donors. Using the UK transplant registry, we identified 4714 kidney-only transplants from controlled DCD donors to adult recipients between 2006-2016; 2832 recipients (60·1%) had immediate graft function and 1882 (39. Read More

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Delayed graft function and rejection are risk factors for cytomegalovirus breakthrough infection in kidney transplant recipients.

Pharmacol Res 2021 Mar 17;167:105565. Epub 2021 Mar 17.

Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Postbus 9600, 2300 RC Leiden, The Netherlands.

Breakthrough cytomegalovirus (CMV) disease during valganciclovir prophylaxis is rare but may cause significant morbidity and even mortality. In order to identify patients at increased risk the incidence of CMV disease was studied in a large population of renal transplant recipients who underwent a kidney transplantation in the Radboud University Medical Center between 2004 and 2015 (n = 1300). CMV disease occurred in 31/1300 patients. Read More

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A prediction model of delayed graft function in deceased donor for renal transplant: a multi-center study from China.

Ren Fail 2021 Dec;43(1):520-529

Tianjin First Central Hospital, Tianjin, China.

Background: Kidneys obtained from deceased donors increase the incidence of delayed graft function (DGF) after renal transplantation. Here we investigated the influence of the risk factors of donors with DGF, and developed a donor risk scoring system for DGF prediction.

Methods: This retrospective study was conducted in 1807 deceased kidney donors and 3599 recipients who received donor kidneys transplants in 29 centers in China. Read More

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December 2021

The predictive value of urinary kidney injury molecular-1 for long-term graft function in kidney transplant patients: a prospective study.

Ann Transl Med 2021 Feb;9(3):244

Department of Nephrology, Molecular Cell Laboratory for Kidney Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Background: Monitoring allograft function during the early stages is crucial, and therefore requires biomarkers more sensitive than serum creatinine (Scr). Kidney injury molecular-1 (KIM-1) is a potent biomarker; however, disparities exist in the literature concerning its predictive value in allograft function. Therefore, this study aimed to evaluate its predictive value for the long-term prognosis of kidney transplantation patients. Read More

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February 2021

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study.

Kidney Res Clin Pract 2021 Mar 5;40(1):162-174. Epub 2021 Mar 5.

Transplant Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: This study evaluated the impact of acute kidney injury (AKI) on posttransplant clinical outcomes for deceased donor (DD) kidney transplantation (KT) using the Kidney Donor Profile Index (KDPI) system.

Methods: Overall, 657 kidney transplant recipients (KTRs) receiving kidneys from 526 DDs from four transplant centers were included. We divided them into the high and low KDPI donor groups by 65%, the KDPI score, and both groups were subdivided into the AKI-DDKT and non-AKI-DDKT subgroups according to AKI in DDs. Read More

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Survival Benefit of Donation After Circulatory Death Kidney Transplantation in Children Compared with Remaining on the Waiting List for a Kidney Donated After Brain Death.

Transplantation 2021 Mar 1. Epub 2021 Mar 1.

Department of Pediatrics. University of Minnesota. Minneapolis, MN. United States Clinical and Translational Science Institute. University of Minnesota. Minneapolis, MN. United States.

Background: Kidneys donated after circulatory death (DCD) are increasingly being used for transplantation in adults to alleviate organ shortage. Pediatric data on survival benefits of DCD transplantation compared with remaining on the waitlist for a kidney donated after brain death (DBD) offer are lacking.

Methods: We used SRTR to identify 285 pediatric (< 18 years) DCD kidney transplants performed between 1987 and 2017. Read More

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Induction therapy with mesenchymal stromal cells in kidney transplantation: a meta-analysis.

Stem Cell Res Ther 2021 Mar 1;12(1):158. Epub 2021 Mar 1.

Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.

Objective: The aim of this meta-analysis was to evaluate the therapeutic effects of mesenchymal stromal cells (MSCs) versus traditional regimens for induction therapy in kidney transplantation (KT), especially the safety of MSC infusion, practicability of MSCs as induction therapy agents, and posttransplant complications.

Methods: PubMed, Embase, EBSCO, Ovid, and the Cochrane Library were searched for prospective clinical trials that compared MSCs with traditional regimens for induction therapy in KT.

Results: Four trials were included, including a total of 197 patients. Read More

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Clinical Outcomes of Older Kidney Transplant Recipients.

Am J Med Sci 2021 Feb 25. Epub 2021 Feb 25.

Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.

Background: Older kidney transplant recipients (OKTR) are vulnerable to infections and AKI, often prompting hospitalization. This study elucidates etiology of hospitalizations, AKI, and outcomes in OKTR.

Methods: Retrospective study of 500 patients age ≥ 60, who underwent kidney transplantation from 2005-2015. Read More

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February 2021

Phase 3 trial Design of the Hepatocyte Growth Factor Mimetic ANG-3777 in Renal Transplant Recipients With Delayed Graft Function.

Kidney Int Rep 2021 Feb 13;6(2):296-303. Epub 2020 Nov 13.

Angion Biomedica, Uniondale, NY.

Introduction: One-third of kidney transplantation patients experience acute kidney injury (AKI) resulting in delayed graft function (DGF), associated with increased risk of graft failure and mortality. Preclinical and phase 2 data indicate that treatment with ANG-3777 (formerly BB3), a hepatocyte growth factor (HGF) mimetic, may improve long-term kidney function and reduce health care resource use and cost, but these data require validation in a phase 3 randomized controlled trial.

Methods: The Graft Improvement Following Transplant (GIFT) trial is a multicenter, double-blind randomized controlled trial, designed to determine the efficacy and safety of ANG-3777 in renal transplantation patients showing signs of DGF. Read More

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February 2021

Rate, Factors, and Outcome of Delayed Graft Function After Kidney Transplantation of Deceased Donors.

Transplant Proc 2021 Feb 18. Epub 2021 Feb 18.

Department of Internal Medicine III/Collaborative Kidney Transplant Center, University Hospital Jena - Friedrich Schiller University, Jena, Germany. Electronic address:

Background: Delayed graft function (DGF) is a frequent complication after kidney transplantation affecting long-term outcome.

Patients And Methods: A total of 525 consecutive recipients (age 54.2 ± 13. Read More

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February 2021

Outcomes of Delayed Graft Function in Kidney Transplant Recipients Stratified by Histologic Biopsy Findings.

Transplant Proc 2021 Feb 9. Epub 2021 Feb 9.

Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Electronic address:

Delayed graft function (DGF) after kidney transplantation is associated with an increased risk of graft failure. We studied the histologic findings among adult kidney transplant recipients transplanted between January 2000 and June 2015 who had DGF and had a kidney biopsy within 14 days of transplant. Death censored graft failure (DCGF) and death at 1 and 3 years after transplant were examined. Read More

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February 2021

Risk factors and outcomes for delayed kidney graft function in simultaneous heart and kidney transplant recipients: A UNOS/OPTN database analysis.

Am J Transplant 2021 Feb 10. Epub 2021 Feb 10.

Division of Nephrology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.

There are no prior studies assessing the risk factors and outcomes for kidney delayed graft function (K-DGF) in simultaneous heart and kidney (SHK) transplant recipients. Using the OPTN/UNOS database, we sought to identify risk factors associated with the development of K-DGF in this unique population, as well as outcomes associated with K-DGF. A total of 1161 SHK transplanted between 1998 and 2018 were included in the analysis, of which 311 (27%) were in the K-DGF (+) group and 850 in the K-DGF (-) group. Read More

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February 2021

Evidence to support a drain-free strategy in kidney transplantation using a retrospective comparison of 500 consecutively transplanted cases at a single center.

BMC Surg 2021 Feb 5;21(1):74. Epub 2021 Feb 5.

Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.

Introduction: Routine placement of surgical drains at the time of kidney transplant has been debated in terms of its prognostic value.

Objectives: To determine whether the placement of a surgical drain affects the incidence rate of developing wound complications and other clinical outcomes, particularly after controlling for other prognostic factors.

Methods: Retrospective analysis of 500 consecutive renal transplant cases who did not (Drain-free, DF) vs. Read More

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February 2021

[Acute renal failure of the donor in encephalic death: A real contraindication to kidney transplantation?]

Prog Urol 2021 Jan 18. Epub 2021 Jan 18.

Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France; Nuffield department of surgical sciences, Oxford university, Oxford, UK.

Introduction: The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation.

Materials And Methods: All of the transplants performed in two university hospitals between 2010 and 2017 were analyzed retrospectively. Read More

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January 2021

Quantitative Assessment of Intraoperative Laser Fluorescence Angiography with Indocyanine Green Predicts Early Graft Function after Kidney Transplantation.

Ann Surg 2020 Dec 30;Publish Ahead of Print. Epub 2020 Dec 30.

Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany Department of Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, D-83022 Rosenheim, Germany Department of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, Germany Department of Biometry and Statistics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany Department of Nephrology, Friedrich Alexander University Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany Department of Urology and Pediatric Urology, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.

Objective: This study was designed to demonstrate the predictive ability of quantitative indocyanine green (ICG) fluorescence angiography for the short-term postoperative outcome, the occurrence of delayed graft function (DGF), and long-term graft survival.

Summary Background Data: DGF is a relevant problem after kidney transplantation; sufficient microperfusion of the allograft is crucial for postoperative organ function. Fluorescence angiography with ICG can serve as an intraoperative quality control of microperfusion. Read More

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December 2020

Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation.

Int Urol Nephrol 2021 Mar 4;53(3):439-446. Epub 2021 Jan 4.

Department of Urology and Renal Transplant, University of Toledo, 3000, Arlington Ave, MS1091, Toledo, OH, 43614, USA.

Background: Delayed graft function (DGF) is a manifestation of acute kidney injury uniquely framed within the transplant process and a predictor of poor long-term graft function1. It is less common in the setting of living donor (LD) kidney transplantation. However, the detrimental impact of DGF on graft survival is more pronounced in LD2. Read More

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Delayed graft function and acute rejection following HLA-incompatible living donor kidney transplantation.

Am J Transplant 2021 04 27;21(4):1612-1621. Epub 2021 Feb 27.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Incompatible living donor kidney transplant recipients (ILDKTr) have pre-existing donor-specific antibody (DSA) that, despite desensitization, may persist or reappear with resulting consequences, including delayed graft function (DGF) and acute rejection (AR). To quantify the risk of DGF and AR in ILDKT and downstream effects, we compared 1406 ILDKTr to 17 542 compatible LDKT recipients (CLDKTr) using a 25-center cohort with novel SRTR linkage. We characterized DSA strength as positive Luminex, negative flow crossmatch (PLNF); positive flow, negative cytotoxic crossmatch (PFNC); or positive cytotoxic crossmatch (PCC). Read More

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The Impact of Hypothermic Pulsatile Machine Perfusion Versus Static Cold Storage: A Donor-Matched Paired Analysis in a Scenario of High Incidence of Delayed Kidney Graft Function.

Ann Transplant 2020 Dec 15;25:e927010. Epub 2020 Dec 15.

Transplant Division, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil.

BACKGROUND The present study analyzed the impact of hypothermic pulsatile machine perfusion (MP) following a long period of static cold (SC) storage in the peculiar Brazilian scenario of high incidence of delayed graft function (DGF), despite good donor characteristics. MATERIAL AND METHODS A retrospective analysis, with a 1-year follow-up, of 206 recipients of donor-matched paired kidneys was performed. Of the 206 donor kidneys, 103 were maintained exclusively in static cold storage (SC group) and 103 were kept on machine perfusion after a period of SC preservation (MP group). Read More

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December 2020

Decreased incidence of acute rejection without increased incidence of cytomegalovirus (CMV) infection in kidney transplant recipients receiving rabbit anti-thymocyte globulin without CMV prophylaxis - a cohort single-center study.

Transpl Int 2021 Feb 31;34(2):339-352. Epub 2020 Dec 31.

Department of Nephrology, Hospital do Rim, Universidade Federal de São Paulo, São Paulo, Brazil.

Induction therapy with rabbit anti-thymocyte globulin (rATG) in low-risk kidney transplant recipients (KTR) remains controversial, given the associated increased risk of cytomegalovirus (CMV) infection. This natural experiment compared 12-month clinical outcomes in low-risk KTR without CMV prophylaxis (January/3/13-September/16/15) receiving no induction or a single 3 mg/kg dose of rATG. We used logistic regression to characterize delayed graft function (DGF), negative binomial to characterize length of hospital stay (LOS), and Cox regression to characterize acute rejection (AR), CMV infection, graft loss, death, and hospital readmissions. Read More

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February 2021

Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation.

BMC Nephrol 2020 12 4;21(1):526. Epub 2020 Dec 4.

Department of Kidney Transplantation, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.

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. Read More

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December 2020

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience.

Front Surg 2020 11;7:583798. Epub 2020 Nov 11.

Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.

To report the University of Florence technique for robot-assisted kidney transplantation (RAKT) from living donor (LD) and deceased donor (DD), highlighting the evolution of surgical indications and technical nuances in light of a single surgeon's learning curve. A dedicated program for RAKT from LDs was developed at our Institution in 2017 and implemented later with a specific framework for DDs. All RAKTs were performed by a single highly experienced surgeon. Read More

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November 2020

Incidence and risk factors for high-level BK viruria: a single center study in China.

Virol J 2020 11 26;17(1):189. Epub 2020 Nov 26.

Department of Organ Transplant, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, No. 152 Aiguo Rd, Nanchang, 330006, China.

Background: BK virus allograft nephropathy is a serious complication after kidney transplantation, and the effect of pre-emptive intervention for high-level BK viruria has been verified, but protocols after kidney transplantation for early identification of high-level viruria are lacking.

Methods: This was a single-center study. The clinical data of the kidney transplant recipients and their donors in our center from January 1, 2015 to December 31, 2018, were collected. Read More

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November 2020

Analysis of risk factors for early urinary tract infection after kidney transplantation.

Transl Androl Urol 2020 Oct;9(5):2211-2217

Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, China.

Background: Urinary tract infection (UTI) is the most common kind of infection in the early stage after kidney transplantation. Although many studies have investigated the risk factors for UTI following kidney transplantation, few studies have focused on the risk factors for UTI in the early stage after transplantation.

Methods: The early-stage data of patients who underwent kidney transplantation between January 2018 and December 2019 in a first-class tertiary hospital in Suzhou, China, were retrospectively analyzed. Read More

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October 2020

Randomised sham-controlled double-blind trial evaluating remote ischaemic preconditioning in solid organ transplantation: a study protocol for the RIPTRANS trial.

BMJ Open 2020 11 16;10(11):e038340. Epub 2020 Nov 16.

Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland

Introduction: Remote ischaemic preconditioning (RIPC) using a non-invasive pneumatic tourniquet is a potential method for reducing ischaemia-reperfusion injury. RIPC has been extensively studied in animal models and cardiac surgery, but scarcely in solid organ transplantation. RIPC could be an inexpensive and simple method to improve function of transplanted organs. Read More

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November 2020

Outcomes of Living-Donor Kidney Transplantation in Female Recipients with Possible Pregnancy-Related Pre-Sensitization According to Donor Relationship.

Ann Transplant 2020 Nov 6;25:e925229. Epub 2020 Nov 6.

Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

BACKGROUND Given that pregnancy is an immune-sensitizing event, female kidney transplant recipients who receive allografts from their offspring or husbands may have a higher risk of rejection and graft failure due to pre-sensitization acquired during pregnancy or childbirth. We investigated the association between donor relatedness (i.e. Read More

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November 2020

The Systemic Immune-Inflammation Index Predicts Clinical Outcomes in Kidney Transplant Recipients.

In Vivo 2020 Nov-Dec;34(6):3349-3360

Department of Surgery, Duke University Medical Center, Durham, NC, U.S.A.

Background: Outcomes after kidney transplantation (KTx) remain limited by delayed graft function (DGF) and acute rejection. Non-invasive biomarkers may help identify patients at increased risk for these events. We examined the association between the systemic immune-inflammation index (SII), a novel inflammatory biomarker, and outcomes after KTx and evaluated its ability to predict post-transplant prognosis. Read More

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The impact of functional delayed graft function in the modern era of kidney transplantation - A retrospective study.

Transpl Int 2021 Jan 28;34(1):175-184. Epub 2020 Nov 28.

Nephrology and Renal Transplant Department, Hospital Clínic, Barcelona, Spain.

The dialysis-based definition of Delayed Graft Function (dDGF) is not necessarily objective as it depends on the individual physician's decision. The functional definition of DGF (fDGF, the failure of serum creatinine to decrease by at least 10% daily on 3 consecutive days during the first week post-transplant), may be more sensitive to reflect recovery after the ischemia-reperfusion injury. We retrospectively analyzed both definitions in 253 deceased donor kidney transplant recipients for predicting death-censored graft failure as primary outcome, using eGFR < 25 ml/min/1. Read More

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January 2021