scholarly journals The Utility of Serial Allograft Biopsies during Delayed Graft Function in Renal Transplantation under Current Immunosuppressive Regimens

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Hilana H. Hatoum ◽  
Anita Patel ◽  
K. K. Venkat
Keyword(s):  
Clinical Significance ◽  
Antithymocyte Globulin ◽  
Graft Function ◽  
Deceased Donor ◽  
Delayed Graft Function ◽  
Humoral Rejection ◽  
Kidney Transplants ◽  
Rabbit Antithymocyte Globulin ◽  
Low Incidence ◽  
Hla Antibody

Delayed graft function (DGF) of kidney transplants increases risk of rejection. We aimed to assess the utility of weekly biopsies during DGF in the setting of currently used immunosuppression and identify variables associated with rejection during DGF. We reviewed all kidney transplants at our institution between January 2008 and December 2011. All patients received rabbit antithymocyte globulin/Thymoglobulin (ATG) or Basiliximab/Simulect induction with maintenance tacrolimus + mycophenolate + corticosteroid therapy. Patients undergoing at least one weekly biopsy during DGF comprised the study group. Eighty-three/420 (19.8%) recipients during this period experienced DGF lasting ≥1 week and underwent weekly biopsies until DGF resolved. Biopsy revealed significant rejection only in 4/83 patients (4.8%) (one Banff 1-A and two Banff 2-A cellular rejections, and one acute humoral rejection). Six other/83 patients (7.2%) had Banff-borderline rejection of uncertain clinical significance. Four variables (ATG versus Basiliximab induction, patient age, panel reactive anti-HLA antibody level at transplantation, and living versus deceased donor transplants) were statistically significantly different between patients with and without rejection, though the clinical significance of these differences is questionable given the low incidence of rejection. Conclusions. Under current immunosuppression regimens, rejection during DGF is uncommon and the utility of serial biopsies during DGF is limited.

scholarly journals Randomized Trial of Machine Perfusion Versus Cold Storage in Recipients of Deceased Donor Kidney Transplants With High Incidence of Delayed Graft Function

2017 ◽  
Vol 3 (5) ◽  
pp. e155 ◽  
Author(s):  
Helio Tedesco-Silva ◽  
Juliano Chrystian Mello Offerni ◽  
Vanessa Ayres Carneiro ◽  
Mayara Ivani de Paula ◽  
Elias David Neto ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cold Storage ◽  
Graft Function ◽  
Deceased Donor ◽  
Delayed Graft Function ◽  
Machine Perfusion ◽  
Kidney Transplants ◽  
Donor Kidney ◽  
Deceased Donor Kidney ◽  
High Incidence

scholarly journals Does Rabbit Antithymocyte Globulin (Thymoglobuline®) Have a Role in Avoiding Delayed Graft Function in the Modern Era of Kidney Transplantation?

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Lluís Guirado
Keyword(s):  
Lower Risk ◽  
Antithymocyte Globulin ◽  
Ischemia Reperfusion ◽  
Graft Loss ◽  
Graft Function ◽  
Delayed Graft Function ◽  
Kidney Graft ◽  
Transplant Recipients ◽  
Rabbit Antithymocyte Globulin ◽  
Risk Patients

Delayed graft function (DGF) increases the risk of graft loss by up to 40%, and recent developments in kidney donation have increased the risk of its occurrence. Lowering the risk of DGF, however, is challenging due to a complicated etiology in which ischemia-reperfusion injury (IRI) leads to acute tubular necrosis. Among various strategies explored, the choice of induction therapy is one consideration. Rabbit antithymocyte globulin (rATG [Thymoglobuline]) has complex immunomodulatory effects that are relevant to DGF. In addition to a rapid and profound T-cell depletion, rATG inhibits leukocyte migration and adhesion. Experimental studies of rATG have demonstrated attenuated IRI-related tissue damage in reperfused tissues, consistent with histological evidence from transplant recipients. Starting rATG intraoperatively instead of postoperatively can improve kidney graft function and reduce the incidence of DGF. rATG is effective in preventing acute rejection in kidney transplant recipients at high immunological risk, supporting delayed calcineurin inhibitor (CNI) introduction which protects the graft from early insults. A reduced rate of DGF has been reported with rATG (started intraoperatively) and delayed CNI therapy compared to IL-2RA induction with immediate CNI in patients at high immunological risk, but not in lower-risk patients. Overall, induction with rATG induction is the preferred choice for supporting delayed introduction of CNI therapy to avoid DGF in high-risk patients but shows no benefit versus IL-2RA in lower-risk individuals. Evidence is growing that intraoperative rATG ameliorates IRI, and it seems reasonable to routinely start rATG before reperfusion.

ATG: Does it Really Burden for Deceased Donor Kidney Transplants with Delayed Graft Function?

2012 ◽  
Vol 94 (10S) ◽  
pp. 962
Author(s):  
H. Sozen ◽  
U. Yýlmaz ◽  
K. Fidan ◽  
Ü. Derici ◽  
G. Ulusal Okyay ◽  
...  
Keyword(s):  
Graft Function ◽  
Deceased Donor ◽  
Delayed Graft Function ◽  
Kidney Transplants ◽  
Donor Kidney ◽  
Deceased Donor Kidney

Factors That Influence Delayed Graft Function in Kidney Transplants: A Single-Center Paired Kidney Analysis

2019 ◽  
Vol 51 (5) ◽  
pp. 1568-1570 ◽  
Author(s):  
F.S. Gorayeb-Polacchini ◽  
H.C. Caldas ◽  
C.R. Gauch ◽  
M.A.S. Ferreira-Baptista ◽  
I.M.M. Fernandes-Charpiot ◽  
...  
Keyword(s):  
Graft Function ◽  
Delayed Graft Function ◽  
Single Center ◽  
Kidney Transplants

scholarly journals Tubular Cell Dropout in Preimplantation Deceased Donor Biopsies as a Predictor of Delayed Graft Function

2021 ◽  
Vol 7 (7) ◽  
pp. e716
Author(s):  
Zachary M. Avigan ◽  
Nikhil Singh ◽  
Judith A. Kliegel ◽  
Marlene Weiss ◽  
Gilbert W. Moeckel ◽  
...  
Keyword(s):  
Graft Function ◽  
Deceased Donor ◽  
Delayed Graft Function ◽  
Tubular Cell
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