We have previously reported that, in DeKAF, DC-GF was associated with both early posttransplant events (early rejection) and, episodic dysfunction after 3 months, with greater long-term impact of the latter.18 A unique aspect of the DeKAF Prospective Cohort is data collected around an “Index biopsy,” performed in response to development of new-onset proteinuria or a 25% elevation in serum Cr level over baseline occurring >90 days post-transplant. DC-GF was most commonly attributed to nonadherence (21%) and rejection (20%), with only 11.5% unknown. 2010. pp. Pathological and clinical characterization of the ‘troubled transplant’: data from the dekaf study. It is more common in recipients of unrelated donor or mismatched stem cell grafts (such as those common with umbilical cord blood) and may occur in 5-10% of patients depending on the degress of mismatch. 2003; 7581291–1295, 9. In other words, is “DWF” really death with allograft function? How do I know this is what the patient has? Comprehensive and very up-to-date review on the pathophysiology, risk factors, and treatment for graft failure. One problem limiting advances is uncertainty regarding the causes and clinical course of late graft failure, characterized as death (or death with function, DWF) and death-censored graft failure (DC-GF). 2008. pp. Large retrospective single-institution study examining the long-term follow-up of patients who experienced graft failure after allogeneic stem cell transplant over a 10-year period. If DWF is a distinct long-term outcome in kidney transplant recipients, there are at least 3 important clinical implications. DWF was defined as death that occurred in recipients not undergoing retransplantation or return to dialysis. Quantification of the early risk of death in elderly kidney transplant recipients. Identifying specific causes of kidney allograft loss. Clinical Trial Notation: A Study of Factors That Affect Long-Term Kidney Transplant Function (DeKAF) NCT00270712. Lorenz et al7 have similarly shown that increasing recipient age, diabetes, and prior dialysis were risk factors for DWF; in their analysis, including <25% deceased donors, donor source was not significant. Vincenti F, Rostaing L, Grinyo J, et al. Am J Transplant. The association of center performance evaluations and kidney transplant volume in the United States. J.E. Frequent monitoring of blood counts, chimerism studies, and follow-up bone marrow biopsy. Schütte-Nütgen K, Finke M, Ehlert S, Thölking G, Pavenstädt H, Suwelack B, Palmes D, Bahde R, Koch R, Reuter S. PLoS One. Primary graft failure occurs by day 28 after transplant when there is: — an absolute neutrophil count of less than 500/ul (with no other cause of myelosuppression). eCollection 2019 Jun 6. 2019 Mar;19(3):781-789. doi: 10.1111/ajt.15102. To view unlimited content, log in or register for free. In contrast, the proportion of patients who experienced DGF in the DWF and DC-GF groups (16%) was higher than in the MF group (7%) (P < 0.001). In contrast, the clinical course after transplantation in DWF patients did not differ before death from those who maintained function throughout. And tubular atrophy with subclinical inflammation in recipients dying with a functioning graft, donor... Unable to identify cause of death in elderly kidney transplant recipients with graft failure treated with a functional at. 21 ( 15 ):5404. doi: 10.1111/ajt.15102 locally estimated scatterplot smoothing loess... Js, Schaeffner E, Chadban S, Vikraman D, Zaaroura a, JM... Ao, Hanson JA, Wolfe RA, et al a new equation to estimate glomerular rate. To identify ( or distinguish ) graft failure is so often a part of important studies and yet poorly! Functional allograft at 90 days ) after transplantation in DWF patients did not differ before death from those maintained. 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