Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function
Jin Zheng,
Xiaojun Hu,
Xiaoming Ding,
Yang Li,
Chenguang Ding,
Puxun Tian,
Heli Xiang,
Xinshun Feng,
Xiaoming Pan,
Hang Yan,
Jun Hou,
Xiaohui Tian,
Zunwei Liu,
Xuzhen Wang,
Wujun Xue
Affiliations
Jin Zheng
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Xiaojun Hu
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Xiaoming Ding
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Yang Li
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Chenguang Ding
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Puxun Tian
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Heli Xiang
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Xinshun Feng
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Xiaoming Pan
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Hang Yan
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Jun Hou
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Xiaohui Tian
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Zunwei Liu
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Xuzhen Wang
Institute of Organ Transplant, Xi’an Jiaotong University
Wujun Xue
Department of Renal Transplantation, Hospital of Nephrology, The First Affiliated Hospital of Medical College, Xi’an Jiaotong University
Background Due to the current high demand for transplant tissue, an increasing proportion of kidney donors are considered extended criteria donors, which results in a higher incidence of delayed graft function (DGF) in organ recipients. Therefore, it is important to fully investigate the risk factors of DGF, and establish a prediction system to assess donor kidney quality before transplantation. Methods A total of 333 donation after cardiac death kidney transplant recipients were included in this retrospective study. Both univariate and multivariate analyses were used to analyze the risk factors of DGF occurrence. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of variables on DGF posttransplant. Results The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters (flow and resistance index) were all correlated. 46 recipients developed DGF postoperatively, with an incidence of 13.8% (46/333). Multivariate logistic regression analysis of the kidney transplants revealed that the independent risk factors of DGF occurrence post-transplantation included donor score (OR = 1.12, 95% CI 1.06–1.19, p < 0.001), Remuzzi score (OR = 1.21, 95% CI 1.02–1.43, p = 0.029) and acute tubular injury (ATI) score (OR = 4.72, 95% CI 2.32–9.60, p < 0.001). Prediction of DGF with ROC curve showed that the area under the curve was increased to 0.89 when all variables (donor score, Remuzzi score, ATI score and HMP resistance index) were considered together. Conclusions Combination of donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.