Predictive factors for delayed graft function (DGF) and its impact on renal graft survival in children: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) *
- 1 November 1999
- journal article
- clinical trial
- Published by Wiley in Pediatric Transplantation
- Vol. 3 (4) , 293-300
- https://doi.org/10.1034/j.1399-3046.1999.00057.x
Abstract
We define delayed graft function (DGF) as the need for dialysis during the first post‐transplant week. We analyzed 5272 transplants, of which 2486 were of living donor (LD) and 2786 were of cadaver donor (CD) origin. Twelve per cent (620/5272) of all patients developed DGF. Donor specific rates were 5.6% for LD and 19.1% for CD patients. Factors predictive of DGF in CD patients were: African‐American race (25%), prolonged cold ischemia (24%), absence of T‐cell induction antibody therapy and absence of HLA‐DR matching. The relative risk (RR) for graft failure due to DGF was 6.02 (p < 0.001) in LD patients and 2.58 (p < 0.001) for CD recipients. Two‐year graft survival (GS) in LD patients without DGF was 89.6%, compared to 41.6% for those with DGF (p < 0.001); in CD patients it was 80.2% and 49.5%, respectively (p < 0.001). Censoring for primary non‐function, GS for LD patients with a functioning graft at 30 d post‐transplant and no DGF was 91.5%, compared to 70.1% for those with DGF (p < 0.001); GS for CD patients was 83.8% and 68.7%, respectively (p < 0.001). However, when patients whose grafts had failed during the first year were censored no differences in GS were noted between patients with and without DGF for either LD or CD recipients. To determine whether DGF acts as an independent risk factor for graft failure, patients were segregated into four groups: rejection with DGF; rejection without DGF; DGF without rejection; and no DGF, no rejection. When these groups were compared DGF emerged as an independent risk factor for graft failure. This large study reviewing pediatric renal transplantation over 10 yr clearly delineates the role of DGF as a major risk factor for graft failure.Keywords
This publication has 18 references indexed in Scilit:
- FACTORS THAT IMPACT ON THE OUTCOME OF SECOND RENAL TRANSPLANTS IN CHILDRENTransplantation, 1996
- DELAYED GRAFT FUNCTION IN THE ABSENCE OF REJECTION HAS NO LONG-TERM IMPACTTransplantation, 1996
- CLINICAL CORRELATES OF CHRONIC REJECTION IN PEDIATRIC RENAL TRANSPLANTATIONTransplantation, 1996
- ANALYSIS OF REJECTION OUTCOMES AND IMPLICATIONS—A REPORT OF THE NORTH AMERICAN PEDIATRIC RENAL TRANSPLANT COOPERATIVE STUDY1Transplantation, 1995
- EPITHELIAL-DERIVED NEUTROPHIL-ACTIVATING FACTOR-78 PRODUCTION IN HUMAN RENAL TUBULE EPITHELIAL CELLS AND IN RENAL ALLOGRAFT REJECTIONTransplantation, 1995
- In vitro and in vivo interleukin-8 production in human renal cortical epitheliaKidney International, 1992
- Systemic Reaction to the Anti–T-Cell Monoclonal Antibody OKT3 in Relation to Serum Levels of Tumor Necrosis Factor and Interferon-αNew England Journal of Medicine, 1989
- THE EFFECTS OF DELAYED FUNCTION OF RECIPIENTS OF CADAVER RENAL ALLOGRAFTSTransplantation, 1986
- THE DETRIMENTAL EFFECTS OF DELAYED GRAFT FUNCTION IN CADAVER DONOR RENAL TRANSPLANTATIONTransplantation, 1984
- Postoperative Chronic Renal FailureAnnals of Surgery, 1975