Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes
| Autor: | Kwangik Hong, Rick D. Hasz, Mona D. Doshi, William Reitsma, Francis L. Weng, Michael J. Goldstein, Bernd Schröppel, Peter P. Reese, Isaac E. Hall, Chirag R. Parikh |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Tissue and Organ Procurement Epidemiology Biopsy Urology Delayed Graft Function Kidney Critical Care and Intensive Care Medicine Donor Selection Predictive Value of Tests Risk Factors Humans Medicine Acute tubular necrosis Kidney transplantation Aged Transplantation medicine.diagnostic_test business.industry Donor selection Graft Survival Original Articles Kidney Tubular Necrosis Acute Middle Aged medicine.disease Kidney Transplantation Tissue Donors United States Confidence interval Surgery Treatment Outcome medicine.anatomical_structure Nephrology Predictive value of tests Relative risk Female business |
| Zdroj: | Clinical Journal of the American Society of Nephrology. 9:573-582 |
| ISSN: | 1555-9041 |
| Popis: | Background and objectives The influence of deceased-donor AKI on post-transplant outcomes is poorly understood. The few published studies about deceased-donor preimplant biopsy have reported conflicting results regarding associations between AKI and recipient outcomes. Design, setting, participants, & measurements This multicenter study aimed to evaluate associations between deceased-donor biopsy reports of acute tubular necrosis (ATN) and delayed graft function (DGF), and secondarily for death-censored graft failure, first adjusting for the kidney donor risk index and then stratifying by donation after cardiac death (DCD) status. Results Between March 2010 and April 2012, 651 kidneys (369 donors, 4 organ procurement organizations) were biopsied and subsequently transplanted, with ATN reported in 110 (17%). There were 262 recipients (40%) who experienced DGF and 38 (6%) who experienced graft failure. DGF occurred in 45% of kidneys with reported ATN compared with 39% without ATN ( P =0.31) resulting in a relative risk (RR) of 1.13 (95% confidence interval [95% CI], 0.9 to 1.43) and a kidney donor risk index–adjusted RR of 1.11 (95% CI, 0.88 to 1.41). There was no significant difference in graft failure for kidneys with versus without ATN (8% versus 5%). In stratified analyses, the adjusted RR for DGF with ATN was 0.97 (95% CI, 0.7 to 1.34) for non-DCD kidneys and 1.59 (95% CI, 1.23 to 2.06) for DCD kidneys ( P =0.02 for the interaction between ATN and DCD on the development of DGF). Conclusions Despite a modest association with DGF for DCD kidneys, this study reveals no significant associations overall between preimplant biopsy-reported ATN and the outcomes of DGF or graft failure. The potential benefit of more rigorous ATN reporting is unclear, but these findings provide little evidence to suggest that current ATN reports are useful for predicting graft outcomes or deciding to accept or reject allograft offers. |
| Databáze: | OpenAIRE |
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