title: Progression of Interstitial Fibrosis during the First Year after Deceased Donor Kidney Transplantation among Patients with and without Delayed Graft Function.
abstract: Delayed graft function is a form of AKI resulting from ischemia-reperfusion injury. Our aim was to study the effect of delayed graft function on the progression of interstitial fibrosis after deceased donor kidney transplantation.
  
  
  
  Our study is a retrospective study of all patients transplanted at our center between July of 2003 and September of 2014 using a kidney from a deceased donor. The primary outcome was the progression of interstitial fibrosis on serial protocol biopsies done during the first year post-transplant. We analyzed the distribution of the change in the Banff interstitial fibrosis (ci) score between the delayed graft function and nondelayed graft function groups for all of the paired biopsies done at time 0 and 12 months post-transplant (Δfibrosis). We also performed a linear mixed model analyzing the difference in the slopes for the progression of mean Banff ci score for all of the biopsies done at time 0 and 1, 4, and 12 months post-transplant.
  
  
  
  There were 343 (36.7%) in the delayed graft function group and 591 in the control group. The biopsy rates for the delayed graft function and nondelayed graft function groups at time 0 were 65.3% (n=224) and 67.0% (n=396), respectively, and at 12 months, they were 64.4% (n=221) and 68.4% (n=404), respectively. Paired biopsies were available for 155 in the delayed graft function group and 283 in the control group. In a risk-adjusted model, Banff ci score >0 on the time 0 biopsy had a higher odds of delayed graft function (odds ratio, 1.70; 95% confidence interval, 1.03 to 2.82). The distribution of the Δfibrosis between 0 and 12 months was similar in delayed graft function and control groups (P=0.91). The slopes representing the progression of fibrosis were also similar between the groups (P=0.66).
  
  
  
  Donor-derived fibrosis may increase the odds of delayed graft function; however, delayed graft function does not seem to increase the progression of fibrosis during the first year after transplantation.
authors: Departments of Medicine and.
authors: Raymond L
authors: RL
authors: Heilman
authors: Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona; and.
authors: Maxwell L
authors: ML
authors: Smith
authors: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors: Byron H
authors: BH
authors: Smith
authors: Departments of Medicine and.
authors: Ibrahim
authors: I
authors: Qaqish
authors: Departments of Medicine and.
authors: Hasan
authors: H
authors: Khamash
authors: Surgery and.
authors: Andrew L
authors: AL
authors: Singer
authors: Departments of Medicine and.
authors: Bruce
authors: B
authors: Kaplan
authors: Surgery and.
authors: Kunam S
authors: KS
authors: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D051799:Delayed Graft Function / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D015427:Reperfusion Injury / Q000150:complications* / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Control Groups; Humans; Reperfusion Injury; Retrospective Studies; Tissue Donors; acute kidney injury; biopsy; delayed graft function; delayed graft function after kidney transplant; fibrosis; interstitial fibrosis; ischemia reperfusion injury and kidney transplant; kidney; kidney transplantation