There is a persistent shortage of allografts available for transplantation, so we envisioned using non-heart beating donation to expand the donor pool. Non-heart beating donors (NHBD) were categorized using four definitions. Controlled donors, consisting of categories III and IV, are the most suitable for NHBD. Delayed graft function is associated with the use of kidneys from such donors, but had no difference on graft survival in the long-term results compared with heart beating donors. The proportion of NHBD of deceased donors differs considerably among countries, but national programs in many nations have now been initiated to increase the rate of non-heart beating donation. In most cases, the organs from NHBD are not available for transplantation in Korea because of legal restrictions. The use of controlled NHBD is encouraged to expand available allografts in Korea, due to the shortage of such allografts
Delayed Graft Function ; Graft Survival ; Heart ; Humans ; Kidney ; Korea ; Tissue Donors ; Transplantation, Homologous ; Transplants ; Warm Ischemia

OBJECTIVETo investigate the etiology and therapy of delayed graft function (DGF) recovery in renal transplant recipients.

METHODSThe clinical data were retrospectively analyzed in 15 renal recipients with DGF. All the 15 patients received hemodialysis along with pulse treatment against acute rejection (AR), or immunosuppressant adjustment, or in situ retransplantation after the resection of the original transplanted kidney according to different etiological factors.

RESULTSAmong the 15 patients, 8 developed AR, 5 showed acute renal tubular necrosis (ATN), 1 had grafting-associated renal vein embolism and 1 had acute cyclosporine nephrotoxication. The renal function recovered within 10 to 35 days after transplantation without complication during the follow-up period (0.5-3.0 years).

CONCLUSIONDGF is a common complication after kidney transplantation mainly due to the occurrence of AR and ATN. Good prognosis is expected if etiology-oriented therapy is performed properly and promptly.

Adult ; Delayed Graft Function ; physiopathology ; therapy ; Female ; Graft Rejection ; physiopathology ; therapy ; Graft Survival ; Humans ; Immunosuppressive Agents ; therapeutic use ; Kidney Transplantation ; Male ; Recovery of Function ; Renal Dialysis ; Retrospective Studies

BACKGROUND: The Korean Network for Organ Sharing (KONOS), which was established in December 31st, 1999, is a nationwide system of deceased donor detection and distribution. From its inception, KONOS has defined marginal donors and used this definition for over 15 years. However, this definition should be reevaluated to determine if it requires revision. This study was conducted to confirm the feasibility of the main study for revision of the marginal donor definition in deceased donor kidney transplantation. METHODS: This study is a retrospective meta-analysis of 786 patients who had deceased donor kidney transplant from six centers. After the data validation process, multivariable analysis was conducted to evaluate whether the marginal donor criteria of KONOS or UNOS expected adequately in terms of graft survival and delayed graft function (DGF). RESULTS: Neither the KONOS or UNOS criteria affected graft survival. Expanded criteria for donors of UNOS was a risk factor for DGF. However, KONOS criteria did not affect DGF. CONCLUSIONS: Based on this preliminary study, there is a need to conduct a study to revise the marginal donor criteria of KONOS in deceased donor kidney transplantation. Such a study should have large scale and long-term follow-up data.
Brain Death ; Delayed Graft Function ; Follow-Up Studies ; Graft Survival ; Humans ; Kidney Transplantation* ; Kidney* ; Retrospective Studies ; Risk Factors ; Tissue Donors*

PURPOSE: The current organ shortage in renal transplantation underscores the importance of optimizing long- term graft survival. Despite the significant improvement in the results of renal transplantation since the introduction of cyclosporine, graft loss after fist year of transplantation remains a significant and unresolved problem. This study showed renal function at 1 month after transplantation as a prognostic factor influencing long-term renal graft survival. METHODS: The results of 683 cases of renal transplantations performed from 1978 to 2001 in our center were analysed. We divided into 3 groups according to the serum creatinine level (group 1: <1.5, group 2: 1.5~2.0, group 3: 2.0<) at first month of transplantation. And risk factors such as donor age (<60 or >60), donor sex, donor type (related, unrelated, cadevaric), recipient age (<60, or >60), recipient sex, HLA matching, acute rejection, delayed graft function were also analysed. RESULTS: The acute rejection rates in each group were 17.1%, 40.6%, 71.7% retrospectively (P=0.000). The frequencies of delayed graft function were 3.9%, 9.0%, 36.2% retrospectively (P=0.000). There was significant difference of graft survival between each group (P=0.000). In addition, graft survival in group with acute rejection showed significant difference according to creatinine level at 1 month. CONCLUSION: We can predict long-term graft survival and early renal function through serum creatinine levels after transplantation. Therefore, serum creatinine level at first month of transplantation was prognostic factor in predicting long-term graft survival.
Creatinine* ; Cyclosporine ; Delayed Graft Function ; Graft Survival ; Humans ; Kidney Transplantation ; Retrospective Studies ; Risk Factors ; Tissue Donors ; Transplants*

BACKGROUND: Delayed graft function (DGF) is the main cause of renal function failure after kidney transplantation. This study aims at investigating the value of hypothermic machine perfusion (HMP) parameters combined with perfusate biomarkers on predicting DGF and the time of renal function recovery after deceased donor (DD) kidney transplantation. METHODS: HMP parameters, perfusate biomarkers and baseline characteristics of 113 DD kidney transplantations from January 1, 2019 to August 31, 2019 in the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analyzed using univariate and multivariate logistic regression analysis. RESULTS: In this study, the DGF incidence was 17.7% (20/113); The multivariate logistic regression results showed that terminal resistance (OR: 1.879, 95% CI 1.145-3.56) and glutathione S-transferase (GST)(OR = 1.62, 95% CI 1.23-2.46) were risk factors for DGF; The Cox model analysis indicated that terminal resistance was an independent hazard factor for renal function recovery time (HR = 0.823, 95% CI 0.735-0.981). The model combining terminal resistance and GST (AUC = 0.888, 95% CI: 0.842-0.933) significantly improved the DGF predictability compared with the use of terminal resistance (AUC = 0.756, 95% CI 0.693-0.818) or GST alone (AUC = 0.729, 95% CI 0.591-0.806). CONCLUSION According to the factors analyzed in this study, the combination of HMP parameters and perfusate biomarkers displays a potent DGF predictive value.
Biomarkers ; Delayed Graft Function ; Graft Survival ; Humans ; Kidney/physiology* ; Kidney Transplantation/adverse effects* ; Organ Preservation ; Perfusion ; Retrospective Studies ; Tissue Donors

BACKGROUND: Kidney transplantation (KT) is the treatment of choice for end-stage renal disease patients. The spouse is a major donor in living KT. Clinical outcomes of spousal donor KT are not inferior to those of living related donor KT. In this study, we compared clinical outcomes between ABO-compatible (ABOc) and ABO-incompatible (ABOi) spousal donor KTs. METHODS: Thirty-two cases of spousal donor KT performed from January 2011 to August 2013 were analyzed retrospectively. Twenty-one ABOc KTs and 11 ABOi KTs were performed. We investigated patient survival, graft survival, acute rejection, graft function, and complications. RESULTS: During follow-up, patient and graft survival rates were 100% in both groups. There were no significant differences in the incidence of delayed graft function, acute rejection, and the change in graft function between the 2 groups. Medical and surgical complications were not significantly different between the groups. CONCLUSION: The clinical outcomes of ABOc and ABOi spousal donor KTs were equivalent. In ABOi KT, an emotionally motivated spousal donor KT may be a good alternative to the problem of the absolute shortage of kidney donations.
Blood Group Incompatibility ; Delayed Graft Function ; Follow-Up Studies ; Graft Rejection ; Graft Survival ; Humans ; Incidence ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Retrospective Studies ; Spouses ; Tissue Donors* ; Transplants

BACKGROUND: Kidney injury molecule-1 (KIM-1) is known as a good ancillary marker of acute kidney injury (AKI) and its expression has also been observed in acute rejection and chronic graft dysfunction. We tested usefulness of KIM-1 as an indicator of acute and chronic renal graft injury by correlating KIM-1 expression with renal graft function and histology. METHODS: A total of 133 zero-time biopsies and 42 follow-up biopsies obtained within 1 year posttransplantation were selected. Renal tubular KIM-1 staining was graded semiquantitatively from 0 to 3 and the extent of staining was expressed as the ratio of KIM-1 positive/CD10 positive proximal tubules using Image J program. RESULTS: KIM-1 was positive in 39.8% of zero-time biopsies. KIM-1 positive cases were predominantly male and had received grafts from donors with older age, deceased donors, and poor renal function at the time of donation, compared with KIM-1 negative cases. KIM-1 expression showed correlation with delayed graft function and acute tubular necrosis. In comparison of KIM-1 expression between stable grafts (n=23) and grafts with dysfunction (n=19) at the time of repeated biopsy, the intensity/extent of KIM-1 staining and renal histology at zero-time did not differ significantly between the two groups. Histologically, KIM-1 expression was significantly increased with both acute and chronic changes of glomeruli, tubules and interstitium, peritubular capillaritis, and arteriolar hyalinosis. CONCLUSIONS: KIM-1 can be used as an ancillary marker of AKI and a nonspecific indicator of acute inflammation and tubulointerstitial fibrosis. However, KIM-1 expression at zero-time is not suitable for prediction of long-term graft dysfunction.
Acute Kidney Injury ; Allografts* ; Biopsy* ; Delayed Graft Function ; Fibrosis ; Follow-Up Studies ; Humans ; Inflammation ; Kidney* ; Male ; Necrosis ; Tissue Donors ; Transplants

Kidney transplantation is the best treatment option for end stage renal disease. As a result of disparity between the demand for kidney transplantation and the supply of suitable organs, kidneys from suboptimal donors have been used in kidney transplantation. Since demonstration of better patient survival, using marginal donor kidney rather than remaining on hemodialysis, more expanded criteria for donor kidneys were adopted in kidney transplantation. Several donor scoring systems, including Nyberg's donor scoring system, donor risk score by Schold, delayed graft function nomogram, kidney donor risk index (KDRI), and histological graft variable have been developed for evaluation of the quality of deceased donor kidneys showing an increased risk for graft dysfunction and loss and for improvement of the stratification; 15% highest risk donors by KDRI and grade C (20~29 points) and grade D (30~39 points) by Nyberg's deceased donor scoring system are compatible with the definition of expanded criteria for kidney donors of United Network for Organ Sharing. Utilization of these scoring systems would be very useful in allocation of expanded criteria for donors for improvement of graft and patient survival.
Delayed Graft Function ; Donor Selection ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Nomograms ; Renal Dialysis ; Risk Assessment ; Tissue Donors ; Transplants

Chronic renal allograft dysfunction (CRAD) has been the rnost frequent cause of graft failure for last decade. Even in cycloporine era the incidence of CRAD has not changed. From Jan 1992 to Dec 1994 118 kidney transplants performed in Seoul National University Hospital had been entered into our database. All patients had been followed for at least 1 year. CRAD is defined if there had been progressive deterioration of renal function that was not explained by other causes and finally serum creatinine (Scr) had doubled from basal Scr after transplantation and has been maintained. Analyzed factors as follows; HLA misrnatch, living or cadaver transplant, ABO mismatch, acute rejecton (AR), frequency and timing of AR, donor age, recipient age, cold ischmic time, delayed graft function, proteinuria, infection. A CRAD has developed in 27 (23%) patients. The incidence of CRAD with time was analyzed by Kaplan-Meier survival analysis and compared with log-rank test. We concluded that in univariate anlaysis the risk factors are acute rejection, frequency of AR, AR after 3 months after tranplantation, age of recipient<15 and cold ischmic time> 40rnin for living transplants. Although HLAMM=0 significantly decreased the risk of CRAD (P<0.05), there was no difference in renal survival between groups of HLAMM>1. AR and HLAMM (HLAMM=O vs. HLAMM>1) were related each other (P=0.02).
Allografts* ; Cadaver ; Creatinine ; Delayed Graft Function ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Proteinuria ; Risk Factors* ; Seoul ; Tissue Donors ; Transplants

In spite of efforts to promote organ donation through media campaigns, educating the public and improved organization for organ retrieval, the number of donors has remained relatively stable over the past few years. On the contrary, adverse scandals such as "buying & selling organs" or "The Exodus to China" for renal transplantation are recent issues in the field of organ transplantation". It has been suggested that non-heart beating donors (NHBD) could bridge the gap between supply and demand for renal transplantation; however, NHB donation is being used to a limited degree. This article reviews the selection criteria, technical approaches and logistical organization, the graft function and survival in NHBD. Actually, the primary non-function of grafts is significantly worse for NHBD kidneys, but the result could be improved by utilizing better patient selection and retrieval team organization. Delayed graft function is also more frequent in NHBD kidneys. This poses problems in the short term, but in the long term it does not seem to influence the outcome. Indeed, NHBD has consistently increased the number of available kidneys and it has no effect on heart beating (HB) donations.
Delayed Graft Function ; Heart ; Humans ; Kidney ; Kidney Transplantation* ; Patient Selection ; Tissue and Organ Harvesting ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants