Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles
Abstract
:1. Introduction
2. Experimental Section
2.1. Patient Selection and Data Acquisition
2.2. Definitions
2.3. Rejection Episodes
2.4. Immunosuppression
2.5. Evaluation of De Novo Donor-Specific Antibodies
2.6. Surgical Technique and Postoperative Treatment
2.7. Data Analysis
3. Results
3.1. Patient characteristics
3.2. Course and Treatment Of Lymphoceles
3.3. Rejection and Graft Function
3.4. Risk Factors for Lymphocele Formation and Treatment
3.5. Donor Specific Antibody Formation
3.6. Patient and Graft Survival
4. Discussion
Considerations for Clinical Practice
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Group A | Group B | Group C | p-Value | |
---|---|---|---|---|
n (number), (%) | 233 (26.8%) | 72 (8.3%) | 562 (64.8%) | |
Mean follow up, years (SD) | 6.2 (2.8) | 6.5 (2.8) | 5.4 (2.8) | 0.006 |
Mean recipient age, years (SD) | 52 (14) | 54 (15) | 50 (15) | 0.016 |
Mean donor age, years (SD) | 53 (15) | 58 (13) | 53 (15) | 0.027 |
Male, n | 149 (64%) | 40 (56%) | 335 (60%) | 0.339 |
Re-transplantation, n | 21 (9%) | 12 (17%) | 60 (11%) | 0.189 |
Median time on dialysis, months (IQR) | 53 (21–87) | 61 (22–85) | 47 (12–84) | 0.112 |
Dialysis modality, n | 0.09 | |||
Hemodialysis: | 201 (86.3%) | 61 (84.7%) | 436 (77.6%) | |
Peritoneal dialysis: | 14 (6%) | 7 (9.7%) | 47 (8.4%) | |
Preemptive: | 10 (4.3%) | 2 (2.8%) | 44 (7.8%) | |
Unknown: | 8 (3.4%) | 2 (2.8%) | 35 (6.2%) | |
Mean HLA-A, B, DR mismatches (SD) | 2.8 (1.7) | 2.9 (1.5) | 2.8 (1.7) | 0.906 |
Median cold ischemia time (cadaveric donation), hours (IQR) | 11 (8.1–15.2) | 11.1 (7.5–15.5) | 11.2 (8–14.4) | 0.961 |
Median cold ischemia time (living donation), hours (IQR) | 2.5 (2.2–3) | 2.4 (2.1–3.2) | 2.5 (2.2–3.1) | 0.99 |
Body mass index, kg/m2 (SD) | 25.8 (4.5) | 25.6 (4.3) | 25.8 (4.6) | 0.939 |
Pre-Tx Diabetes (all types) | 22 (9.4%) | 8 (11.1%) | 42 (7.5%) | 0.391 |
Living donation, n | 60 (26%) | 14 (19%) | 210 (37%) | <0.001 |
Donor creatinine, mg/dL (IQR) | 0.86 (0.70–1.04) | 0.87 (0.71–1.11) | 0.80 (0.69–0.99) | 0.103 |
KDPI (SD)(deceased donor kidneys, n = 581) | 65 (29) | 77 (23) | 63 (30) | 0.004 |
Living kidney donor profile indices (LKDPI) (living donor kidneys, n = 284) | 20 (24) | 20 (29) | 23 (24) | 0.572 |
Delayed graft function, n | 98 (42.1%) | 38 (52.7%) | 182 (32.4%) | <0.001 |
Preformed donor specific antibodies, n | 6 (0.7%) | 1 (0.1%) | 27 (3.1%) | 0.173 |
Rejection episode (T-cell mediated rejection + antibody mediated rejection + Borderline) | 72 (30.9%) | 25 (34.7%) | 122 (21.7%) | 0.004 |
T-cell mediated rejection | 48 (20.6%) | 18 (25%) | 92 (16.4%) | 0.111 |
Primary immunosuppression at transplantation | ||||
- Tacrolimus | 99 (43%) | 22 (31%) | 314 (56%) | <0.001 |
- Cyclosporine | 127 (55%) | 47 (65%) | 233 (42%) | <0.001 |
- mammalian target of rapamycin (mTOR) inhibitor | 4 (2%) | 1 (1%) | 5 (1%) | 0.499 |
- mycophenolic acid | 224 (96%) | 71 (99%) | 542 (96%) | 0.699 |
- others | 19 (8%) | 3 (4%) | 37 (7%) | 0.523 |
- Basiliximab induction | all patients |
Group A | Group B | |||||||
---|---|---|---|---|---|---|---|---|
Monovariate | Multivariate | Monovariate | Multivariate * | |||||
Variable | OR | p-Value | OR | p-Value | OR | p-Value | OR | p-Value |
Mean recipient age per year | 1.01 | 0.008 | 1.02 | 0.039 | ||||
Mean donor age per year | 1.01 | 0.131 | 1.02 | 0.008 | 1.02 | 0.023 | ||
Male sex | 0.91 | 0.498 | 1.25 | 0.377 | ||||
Re-transplantation | 1.02 | 0.948 | 1.76 | 0.093 | ||||
Median time on dialysis per month | 1.00 | 0.079 | 1.00 | 0.568 | ||||
Mean HLA-mismatches per mismatch | 1.01 | 0.835 | 1.03 | 0.657 | ||||
Median cold ischemia time per hour | 1.03 | 0.005 | 1.04 | 0.035 | ||||
Donor creatinine per mg/dL | 1.15 | 0.189 | 1.15 | 0.373 | ||||
Living donation | 0.54 | <0.001 | 0.55 | <0.001 | 0.47 | 0.014 | ||
BMI per kg/m2 | 1.00 | 0.779 | 0.99 | 0.755 | ||||
Diabetes | 1.35 | 0.23 | 1.43 | 0.37 | ||||
Rejection episode | 1.68 | 0.001 | 1.61 | 0.003 | 1.65 | 0.056 | ||
DGF | 1.68 | 0.001 | 2.06 | 0.004 | 1.9 | 0.011 |
Monovariate | Multivariate * | |||
---|---|---|---|---|
n | HR | p-Value | HR | p-Value |
Mean recipient age per year | 1.03 | <0.001 | ||
Mean donor age per year | 1.04 | <0.001 | 1.04 | <0.001 |
Male sex | 1.29 | 0.180 | ||
Re-transplantation | 1.59 | 0.079 | 1.74 | 0.046 |
Median time on dialysis per month | 1.00 | 0.230 | ||
Mean HLA-mismatches per mismatch | 1.24 | <0.001 | ||
Median cold ischemia time per hour | 1.03 | 0.056 | ||
Living donation | 0.47 | 0.002 | ||
Diabetes | 2.34 | 0.001 | ||
BMI per kg/m2 | 1.06 | 0.006 | ||
Rejection episode | 2.5 | <0.001 | 1.94 | 0.001 |
DGF | 2.52 | <0.001 | 1.73 | 0.008 |
Lymphocele treatment | 0.91 | 0.788 | n.a. | n.s. |
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Lehner, L.J.; Hohberger, A.; Marschke, L.; Lachmann, N.; Peters, R.; Friedersdorff, F.; Khadzhynov, D.; Halleck, F.; Budde, K.; Staeck, O.; et al. Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles. J. Clin. Med. 2020, 9, 2841. https://doi.org/10.3390/jcm9092841
Lehner LJ, Hohberger A, Marschke L, Lachmann N, Peters R, Friedersdorff F, Khadzhynov D, Halleck F, Budde K, Staeck O, et al. Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles. Journal of Clinical Medicine. 2020; 9(9):2841. https://doi.org/10.3390/jcm9092841
Chicago/Turabian StyleLehner, Lukas J., Arnim Hohberger, Lisanne Marschke, Nils Lachmann, Robert Peters, Frank Friedersdorff, Dmytro Khadzhynov, Fabian Halleck, Klemens Budde, Oliver Staeck, and et al. 2020. "Analysis of Risk Factors and Long-Term Outcomes in Kidney Transplant Patients with Identified Lymphoceles" Journal of Clinical Medicine 9, no. 9: 2841. https://doi.org/10.3390/jcm9092841