Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2017; 7(1): 34-42
Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.34
Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol
Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube
Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom
Author contributions: All the authors contributed to the manuscript.
Institutional review board statement: This study was approved by the Imperial College Renal and Transplant Centre, Transplant Clinical and Research Group.
Informed consent statement: No individual informed consent was required for this study.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: No data were created no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michelle Willicombe, MA, MRCP, MD, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, South Wharf Road, London W12 0HS, United Kingdom. michelle.willicombe@imperial.nhs.uk
Telephone: +44-020-33135165 Fax: +44-020-33135169
Received: August 8, 2016
Peer-review started: August 10, 2016
First decision: September 12, 2016
Revised: October 27, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 24, 2017
Abstract
AIM

To analyse the risk factors and outcomes of delayed graft function (DGF) in patients receiving a steroid sparing protocol.

METHODS

Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135 (31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression protocol.

RESULTS

Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function (PGF) group respectively, P = 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively, P < 0.001. Overall rejection free survival was no different between the DGF and PGF groups with a 1 and 5 year rejection free survival in the DGF group of 77.7% and 67.8% compared with 81.3% and 75.3% in the PGF group, P = 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis vintage.

CONCLUSION

Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF.

Keywords: Allograft failure, Deceased donors, Delayed graft function, Cold ischaemic time, Rejection, Steroid sparing, Alemtuzumab

Core tip: Alemtuzumab induction may help mitigate the early rejection risk associated with delayed graft function following renal transplantation. This may help with the management of recipients of transplants at high risk of delayed graft function, as it may lessen the need for repeated histological sampling.