The Experts below are selected from a list of 10701 Experts worldwide ranked by ideXlab platform
Michael L. Nicholson - One of the best experts on this subject based on the ideXlab platform.
-
Non‐Heart Beating Donor Kidneys with Delayed Graft Function Have Superior Graft Survival Compared with Conventional Heart‐Beating Donor Kidneys That Develop Delayed Graft Function
American Journal of Transplantation, 2003Co-Authors: Nicholas R. Brook, Steven A. White, J.r. Waller, Peter S. Veitch, Michael L. NicholsonAbstract:Delayed Graft Function may have an association with reduced Graft survival, and nonheart-beating donor (NHBD) kidneys have higher rates of Delayed Graft Function (DGF) than heart-beating donor (HBD) kidneys. This study compared outcome of renal transplants from HBDs who developed DGF, with NHBDs who developed DGF. All recipients of HBD and NHBD kidneys who developed DGF were identified during a 10-year period. All patients with Graft primary nonFunction were excluded from analysis. Four hundred and fifty-six Functioning transplants were performed. Delayed Graft Function occurred in 69 (17%) HBD and 55 (93%) NHBD kidneys. The Grafts developing DGF were well matched for donor and recipient age. The rate of acute rejection was similar; [n = 16/69 (23%) HBD vs. n = 13/55 (24%) NHBD]. Cold ischaemia was 21 h in the HBD group and 17 h in NHBD group (p > 0.05). Serum creatinine was similar for both groups at 1.3 and 6 years (p > 0.05 for all time points). Graft survival in the NHBD recipients with DGF was significantly better at 3 years (84%) compared with recipients of a HBD renal transplant that developed DGF (73%) (p
-
non heart beating donor kidneys with Delayed Graft Function have superior Graft survival compared with conventional heart beating donor kidneys that develop Delayed Graft Function
American Journal of Transplantation, 2003Co-Authors: Nicholas R. Brook, Steven A. White, J.r. Waller, Peter S. Veitch, Michael L. NicholsonAbstract:Delayed Graft Function may have an association with reduced Graft survival, and nonheart-beating donor (NHBD) kidneys have higher rates of Delayed Graft Function (DGF) than heart-beating donor (HBD) kidneys. This study compared outcome of renal transplants from HBDs who developed DGF, with NHBDs who developed DGF. All recipients of HBD and NHBD kidneys who developed DGF were identified during a 10-year period. All patients with Graft primary nonFunction were excluded from analysis. Four hundred and fifty-six Functioning transplants were performed. Delayed Graft Function occurred in 69 (17%) HBD and 55 (93%) NHBD kidneys. The Grafts developing DGF were well matched for donor and recipient age. The rate of acute rejection was similar; [n = 16/69 (23%) HBD vs. n = 13/55 (24%) NHBD]. Cold ischaemia was 21 h in the HBD group and 17 h in NHBD group (p > 0.05). Serum creatinine was similar for both groups at 1.3 and 6 years (p > 0.05 for all time points). Graft survival in the NHBD recipients with DGF was significantly better at 3 years (84%) compared with recipients of a HBD renal transplant that developed DGF (73%) (p < 0.05), and at 6 years (62% survival for HBDs and 84% survival for NHBDs). This study shows that Graft survival was better for NHBD kidneys up to 6 years after transplantation.
Maha Mohamed - One of the best experts on this subject based on the ideXlab platform.
-
predictors and outcomes of Delayed Graft Function after living donor kidney transplantation
Transplant International, 2016Co-Authors: Robert R Redfield, Joseph R Scalea, Tiffany J Zens, Brenda Muth, Dixon B Kaufman, Arjang Djamali, Brad C Astor, Maha MohamedAbstract:Summary Delayed Graft Function (DGF) following deceased donor kidney transplantation is associated with inferior outcomes. Delayed Graft Function following living-donor kidney transplantation is less common, but its impact on Graft survival unknown. We therefore sought to determine risk factors for DGF following living-donor kidney transplantation and DGF's effect on living-donor kidney Graft survival. We analyzed living-donor kidney transplants performed between 2000 and 2014 in the UNOS dataset. A total of 64 024 living-donor kidney transplant recipients were identified, 3.6% developed DGF. Cold ischemic time, human leukocyte antigen mismatch, donor age, panel reactive antibody, recipient diabetes, donor and recipient body mass index, recipient race and gender, right nephrectomy, open nephrectomy, dialysis status, ABO incompatibility, and previous transplants were independent predictors of DGF in living-donor kidney transplants. Five-year Graft survival among living-donor kidney transplant recipients with DGF was significantly lower compared with Graft survival in those without DGF (65% and 85%, respectively, P < 0.001). DGF more than doubled the risk of subsequent Graft failure (hazard ratio = 2.3, 95% confidence interval: 2.1–2.6; P < 0.001). DGF after living-donor kidney transplantation is associated with inferior alloGraft outcomes. Minimizing modifiable risk factors may improve outcomes in living-donor kidney transplantation.
Arthur J. Matas - One of the best experts on this subject based on the ideXlab platform.
-
Delayed Graft Function, ACUTE REJECTION, AND OUTCOME AFTER CADAVER RENAL TRANSPLANTATION: A Multivariate Analysis
Transplantation, 1995Co-Authors: Christoph Troppmann, K. J. Gillingham, Enrico Benedetti, P. S. Almond, Rainer W G Gruessner, Najarian Js, Arthur J. MatasAbstract:The impact of Delayed Graft Function on outcome after cadaver renal transplantation has been controversial, but most authors fail to control their analyses for the presence or absence of rejection. We studied 457 adult recipients of primary cadaver alloGrafts at a single institution during the cyclosporine era. All patients received sequential immunosuppression. The incidence of Delayed Graft Function (defined as dialysis being required during the first week after transplant) was 23%. There was a significant association between Delayed Graft Function and cold ischemia time >24 hr (P=0.0001) and between Delayed Graft Function and the occurrence of at least one biopsy-proven rejection episode (P=0.004). Actuarial Graft survival was not significantly different when comparing Delayed Graft Function versus no Delayed Graft Function for patients without rejection (P=0.2). However, it was significantly worse for patients with both Delayed Graft Function and rejection versus those with Delayed Graft Function but no rejection (P=0.006), as well as for Grafts preserved >24 hr versus ≤24 hr (P=0.007). By multivariate analysis, Delayed Graft Function per se was not a significant risk factor for decreased Graft survival for patients without rejection (P=0.42). In contrast, rejection significantly decreased Graft survival for Grafts with immediate Function (relative risk =2.3, P=0.0002), particularly in combination with Delayed Graft Function (relative risk =4.2, P 24 hr was also a significant risk factor (relative risk =1.9, P=0.02), other variables (preservation mode, 0 HLA Ag mismatch, age at transplantation, gender, diabetic status, and panel-reactive antibody at transplantation) had no impact on Graft survival. Patient survival was significantly affected by the combination of Delayed Graft Function and rejection (relative risk =3.1, P 50 years (relative risk =2.6, P
-
Delayed Graft Function acute rejection and outcome after cadaver renal transplantation a multivariate analysis
Transplantation, 1995Co-Authors: Christoph Troppmann, K. J. Gillingham, Enrico Benedetti, P. S. Almond, Rainer W G Gruessner, J S Najarian, Arthur J. MatasAbstract:The impact of Delayed Graft Function on outcome after cadaver renal transplantation has been controversial, but most authors fail to control their analyses for the presence or absence of rejection. We studied 457 adult recipients of primary cadaver alloGrafts at a single institution during the cyclosporine era. All patients received sequential immunosuppression. The incidence of Delayed Graft Function (defined as dialysis being required during the first week after transplant) was 23%. There was a significant association between Delayed Graft Function and cold ischemia time >24 hr (P=0.0001) and between Delayed Graft Function and the occurrence of at least one biopsy-proven rejection episode (P=0.004). Actuarial Graft survival was not significantly different when comparing Delayed Graft Function versus no Delayed Graft Function for patients without rejection (P=0.2). However, it was significantly worse for patients with both Delayed Graft Function and rejection versus those with Delayed Graft Function but no rejection (P=0.006), as well as for Grafts preserved >24 hr versus ≤24 hr (P=0.007). By multivariate analysis, Delayed Graft Function per se was not a significant risk factor for decreased Graft survival for patients without rejection (P=0.42). In contrast, rejection significantly decreased Graft survival for Grafts with immediate Function (relative risk =2.3, P=0.0002), particularly in combination with Delayed Graft Function (relative risk =4.2, P 24 hr was also a significant risk factor (relative risk =1.9, P=0.02), other variables (preservation mode, 0 HLA Ag mismatch, age at transplantation, gender, diabetic status, and panel-reactive antibody at transplantation) had no impact on Graft survival. Patient survival was significantly affected by the combination of Delayed Graft Function and rejection (relative risk =3.1, P 50 years (relative risk =2.6, P<0.0001), and diabetes (relative risk =1.8, P=0.006). Further studies are necessary to elucidate the mechanisms linking Delayed Graft Function and rejection, which, in combination, lead to poor alloGraft outcome
-
Fixed‐Rate Reimbursement Fails to Cover Costs for Patients with Delayed Graft Function
Pharmacotherapy, 1991Co-Authors: P. Stephen Almond, Arthur J. Matas, Daniel M. CanafaxAbstract:Medicare uses a fixed reimbursement schedule to pay the initial hospital costs for renal transplantation. This creates the potential to underpay for patients who develop the common complication of Delayed Graft Function. We undertook a pilot study to determine if Delayed Graft Function resulted in higher hospital charges and thus a loss in revenue when caring for these patients. Of 34 patients who experienced Delayed Graft Function between October 12, 1987 and July 7, 1989, 9 (group 1) were randomly selected for study. During this same period 136 patients had immediate Graft Function; from them, another 9 (group 2) were selected by matching age, sex, and date of transplantation. The average (±SD) hospital stays for groups 1 and 2 were 17 ± 8 and 10 ± 2 days, respectively (p < 0.001). The average time on dialysis for group 1 was 10.3 ± 6.3 days (range 2–22 days). All dollars values were adjusted to a 1989 level, and we excluded kidney acquisition costs and professional fees. The average per patient charges for group 1 were $41,474 ± 15,211 (range $21,926–$66,311), compared with $23,774 ± 3245 (range $19,317-$29,702) for group 2 (p< 0.001). We adjusted the charge values to estimate actual costs by using our hospital's average cost:charge ratio of 0.90 for 1987 and 1988, and 0.85 for 1989; the group 1 and group 2 average patient costs were $37,157 ± 13,836 and $21,397 ± 2921, respectively. The difference between Medicare reimbursement (1987=$24,997, 1988=$20,832, 1989=$20,879) and estimated costs for group 1 patients was an average loss of $13,544, with two patients exceeding the reimbursement amount, and for group 2 patients, a gain of $1749, with five patients exceeding the reimbursement amount. We conclude that Delayed Graft Function prolonged initial hospital stay, creating costs that exceeded the Medicare fixed reimbursement rate for these patients, resulting in loss of revenue.
Nicholas R. Brook - One of the best experts on this subject based on the ideXlab platform.
-
Non‐Heart Beating Donor Kidneys with Delayed Graft Function Have Superior Graft Survival Compared with Conventional Heart‐Beating Donor Kidneys That Develop Delayed Graft Function
American Journal of Transplantation, 2003Co-Authors: Nicholas R. Brook, Steven A. White, J.r. Waller, Peter S. Veitch, Michael L. NicholsonAbstract:Delayed Graft Function may have an association with reduced Graft survival, and nonheart-beating donor (NHBD) kidneys have higher rates of Delayed Graft Function (DGF) than heart-beating donor (HBD) kidneys. This study compared outcome of renal transplants from HBDs who developed DGF, with NHBDs who developed DGF. All recipients of HBD and NHBD kidneys who developed DGF were identified during a 10-year period. All patients with Graft primary nonFunction were excluded from analysis. Four hundred and fifty-six Functioning transplants were performed. Delayed Graft Function occurred in 69 (17%) HBD and 55 (93%) NHBD kidneys. The Grafts developing DGF were well matched for donor and recipient age. The rate of acute rejection was similar; [n = 16/69 (23%) HBD vs. n = 13/55 (24%) NHBD]. Cold ischaemia was 21 h in the HBD group and 17 h in NHBD group (p > 0.05). Serum creatinine was similar for both groups at 1.3 and 6 years (p > 0.05 for all time points). Graft survival in the NHBD recipients with DGF was significantly better at 3 years (84%) compared with recipients of a HBD renal transplant that developed DGF (73%) (p
-
non heart beating donor kidneys with Delayed Graft Function have superior Graft survival compared with conventional heart beating donor kidneys that develop Delayed Graft Function
American Journal of Transplantation, 2003Co-Authors: Nicholas R. Brook, Steven A. White, J.r. Waller, Peter S. Veitch, Michael L. NicholsonAbstract:Delayed Graft Function may have an association with reduced Graft survival, and nonheart-beating donor (NHBD) kidneys have higher rates of Delayed Graft Function (DGF) than heart-beating donor (HBD) kidneys. This study compared outcome of renal transplants from HBDs who developed DGF, with NHBDs who developed DGF. All recipients of HBD and NHBD kidneys who developed DGF were identified during a 10-year period. All patients with Graft primary nonFunction were excluded from analysis. Four hundred and fifty-six Functioning transplants were performed. Delayed Graft Function occurred in 69 (17%) HBD and 55 (93%) NHBD kidneys. The Grafts developing DGF were well matched for donor and recipient age. The rate of acute rejection was similar; [n = 16/69 (23%) HBD vs. n = 13/55 (24%) NHBD]. Cold ischaemia was 21 h in the HBD group and 17 h in NHBD group (p > 0.05). Serum creatinine was similar for both groups at 1.3 and 6 years (p > 0.05 for all time points). Graft survival in the NHBD recipients with DGF was significantly better at 3 years (84%) compared with recipients of a HBD renal transplant that developed DGF (73%) (p < 0.05), and at 6 years (62% survival for HBDs and 84% survival for NHBDs). This study shows that Graft survival was better for NHBD kidneys up to 6 years after transplantation.
Chirag R Parikh - One of the best experts on this subject based on the ideXlab platform.
-
Delayed Graft Function phenotypes and 12 month kidney transplant outcomes
Transplantation, 2017Co-Authors: Isaac E Hall, Peter P Reese, Mona D Doshi, Francis L Weng, Bernd Schroppel, William S Asch, Joseph Ficek, Heather Thiessenphilbrook, Chirag R ParikhAbstract:Background Ischemia-reperfusion injury (IRI) leading to Delayed Graft Function, defined by the United Network for Organ Sharing as dialysis in the first week (UNOS-DGF), associates with poor kidney transplant outcomes. Controversies remain, however, about dialysis initiation thresholds and the utility for other criteria to denote less severe IRI, or slow Graft Function (SGF).
-
is Delayed Graft Function causally associated with long term outcomes after kidney transplantation instrumental variable analysis
Transplantation, 2013Co-Authors: Neel M Butala, Peter P Reese, Mona D Doshi, Chirag R ParikhAbstract:Background While some studies have found an association between Delayed Graft Function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. We investigated this relationship using an instrumental variables model (IVM), a quasi-randomization technique for drawing causal inferences.