III. Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre- implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function
- Please provide a summary of this article
- What is meant by the journal impact factor?
The cadaver renal transplant program is associated with high risk of delayed graft function…. Due to increase in demand there is more usage of DCD kidneys to reduce the waiting time of all patients on hemodialysis…
The above study is a retrospective study analyzing 333 donor after cardiac death kidney recipients in relation with donor clinical scores, histologic scores (Remuzzi and ATI scores), Resistive index obtained during the hypothermic machine perfusion and the occurence of DGF…
The donor clinical score includes donor age, primary disease, death from CVD, baseline creatinine before donation, history of Hypertension, CPR and Hypotension..This is comphrensive clinical tool developed in the deceased donor…
Remuzzi score is well known histopathological score obtained in the frozen section of the biopsies from donor kidney to assess the chronicity before transplant.. However expert pathological advice is always needed before making a decision….
The ATI score assess the ischemic tubular injury….
Hypothermic machine perfusion removes microthrombi and allow assessment of viability of the kidney..The Resisitive index can also be assessed here….
The incidence of DGF was 13.8% in this study….
The study found good correlation between 3 parameters (donor clincal scores, Remuzzi score, ATI scores, RI)…They found no correlation between histological criteria and RI….The risk factors for DGF includes higher donor score, higher remuzzi score and ATI and HMP RI>3…the combined use of all the 3 parameters is associzted with significant increase in the area under the curve and better prediction of DGF….
Impact factor of journals:
It is a way to measure the research performance and importance of a journal…It measures the frequency of citation of the articles published in the journal for the previos 2 years….It is calculated by the total number of citations published in the current year divided by the total number of articles published in the previous 2 years…IF >10 is excellent and IF 1 is average
Extended criteria deceased donors have high incidence of graft failure, delayed recovery of graft function and other related complications after kidney transplantation
The donor scoring system includes
Hypothermic mechanical perfusion reduces DGF by providing more optimal environment.
It is important to identify risk factors of DGF, because it may increase risk of rejection, increase hospitalization time and cost, and may reduce survival of graft.
This retrospective study evaluated the correlation of donor patient parameters, kidney pre-implant pathology Remuzzi scores and HMP parameters to select the best donor easily.
The study showed:
Donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation.
What is meant by the journal impact factor?
Impact factor is commonly used to evaluate the relative importance of a journal within its field and to measure the frequency with which the “average article” in a journal has been cited in a particular time period. Journal which publishes more review articles will get highest IFs.
Introduction:
Quality of donor kidneys and their suitability for transplantation need to be more accurately assessed in order to increase the likelihood of successful engraftment.
Quality assessment of a donor kidney is a comprehensive analysis:
Clinical indicators of donor patients before donor kidney acquisition:
donor’s age, donor scoring system creatinine level ,primary diseases, history of hypertension, pre-donation occurrence of cardiopulmonary resuscitation (CPR) and hypotension.
Histopathological evaluation of the donor kidney via biopsy is an important component of the comprehensive evaluation, especially for ECD evaluation
The pre-implantation biopsy is performed not only to evaluate the potential chronic changes in renal structure, but also to assess ischemic injury in the donated kidney.
The assessment of mechanical perfusion indicators during donor kidney maintenance Hypothermic mechanical perfusion (HMP) has been shown to mitigate DGF.
, all of which are closely related to DGF after kidney transplantation.
Aim of the study:
The correlation of donor patient parameters, kidney pre-implant pathology Remuzzi scores and HMP parameters were analyzed collectively, instead of individually, to enrich the comprehensive evaluation of donor kidney quality.
Materials and methods Study:
We retrospectively studied the records of 181 donors and 333 recipients of a single kidney transplant at Department of Kidney Transplant, the First Affiliated Hospital of Xi’an Jiaotong University from January 2018 to September 2019.
The donor scoring system:
The donor scoring system included the donor’s age, primary disease, sCr levels prior to organ recovery, history of hypertension, CPR incidence and hypotension duration.
Machine perfusion:
All DCD kidneys included in our study were perfused in situ and preserved by an HMP device (Life Port, Organ Recovery Systems).
Pre-implantation biopsy evaluation:
Pre-implantation biopsies were performed by the transplant surgeon using a 16G Bard needle. Two biopsies were obtained for each donation kidney.
Discussion
That donor score, Remuzzi score and ATI all were the independence risk factor of DGF.
This indicates that both acute and chronic lesions of donation kidney play an important role in the occurrence of DGF, which consistent with other studies.
Combining donor score, Remuzzi score, ATI and HMP RI 3 together provides the most accurate prediction of DGF.
Conclusion:
The study provides a new way to comprehensively evaluate donor kidneys by combining donor score, Remuzzi score, ATI and HMP RI 3.
The numbers of citation of an article in a particular years compared to total citations of articles.
Introduction
Aside from a living relative, donation after an individual’s death has become the only source of transplantable organs in China since 2015 which only minimally alleviates the shortage of organ sources for ill patients. At present, more than 10,000 organ transplants are carried out in China every year, including kidney, liver, heart, lung, pancreas and small intestine. However, most deceased donation donors are considered extended criteria donors (ECD); while a patient may receive an organ, its quality and likelihood for full engraftment cannot be guaranteed.
increase the likelihood of successful engraftment. The quality assessment of a donor kidney is a comprehensive analysis that includes clinical indicators of donor patients before donor kidney acquisition, the visual observation after donor kidney acquisition and the assessment of mechanical perfusion
The incidence of DGF is on the rise because of an increasing use of marginal kidneys in an era of organ shortage Risk factors for DGF are numerous and stem from multiple sources in the transplant chain starting from the donor to its final allocation in the recipient . DGF refers to the acute kidney injury which caused by CPR or hypotension during the donation process and could be reflected by high sCr before donation . Our data showed that donor score, Remuzzi score and ATI all were the independence risk factor of DGF.
Interestingly, there was no correlation between ATI
and HMP parameters. we speculate that the main lesion site of acute kidney injury was the renal tubule, which has little influence on microcirculation. In addition, there was no statistical correlation between glomerular sclerosis (GS) and HMP parameters (data not shown). One possibility is that the glomerulosclerosis ratio of most cases in our study was lower than 20%, which would not overtly affect HMP parameters. Another other reason for a lack of correlation in these parameters might be related to the technical and practical limitations of fine needle puncture and biopsy sampling.
In conclusion, our study provides a new way to comprehensively evaluate donor kidneys by combining clinical characteristics, biopsy histopathology features and HMP parameters. Donor score, Remuzzi score and HMP parameters were correlated with each other in our study. In particular, donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI [1]3 were risk factors of DGF occurrence. Furthermore, donor score, Remuzzi score and ATI were independent risk factors for DGF occurrence post-transplantation. Importantly, our analysis shows that donor score, donation kidney Remuzzi score and HMP parameters combined together can not only evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF.
This article investigated the risk factors of DGF to establish a prediction system to assess donor kidney quality before transplantation. it included 333 kidney transplant recipients of DCD kidneys who were studied retrospectively from 2018 to 2019. The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters (flow and resistance index) were all correlated. DGF occurred in 46 recipients. donor score, Remuzzi score and acute tubular injury (ATI) scoreshowed significant association with DGF in the multivariate logistic regression analysis. When all the four scores were combined , the prediction of the ROC curve increased. The sensitivity and specificity of predicting DGF were 0.804 and 0.805, respectively. So, the combined use of donor score, donation kidney Remuzzi score and HMP parameters can evaluate the quality of donor kidney and predict the occurrence of DGF. There was no correlation between ATI and HMP parameters and between glomerular sclerosis and HMP parameters.
The impact factor of a journal is calculated by dividing the number of current year citations to the source items published in that journal during the previous two years. It is denoted as a ratio between citations and recent citable items published
The study deals with assessment of deceased donor kidneys regarding clinical characteristics, histopathology and HMP. The aim is to prevent DGF as DGF has significant impact of risk for acute rejection and increased hospitalization in addition to increased cost.
Clinical indicators eg: donor age, original disease, h/o hypertension, pre-donation serum creatinine , CPR history, hypotension ; all are checked for, as they can be related to the development of post transplantation DGF.
HMP plays an important role in prevention of DGF through removal of residual renal micro thrombi during monitoring of renal function. This gives the organ a better chance regarding preservation during waiting for transplant. The organ is also treated with agents to decrease ischemia or repercussion injury, effecting more decreasing the risk of DGF.
Acute and chronic lesions of the donor kidney have an impact on the occurrence of DGF. KDPI evaluates the risk of graft failure. Remuzzi score is used to evaluate for chronic lesions in donor kidney. Both play a role in estimating DGF risk.
No correlation was found between ATI& HMP parameters. This is attributed to fact that the main lesion site of was found to be kidney tubule, which are not having much impact on microcirculation. Microcirculation is affected by HMP.
To conclude ,the study found that DGF can be predicted from donation kidney Remuzzi score, and HMP parameters in combination for evaluation of the quality of the donor kidney.
The increase in patients on the waiting list leads to greater acceptance of deceased donors and with it the adoption of extended criteria , so that the quality of the total graft cannot be guaranteed, as the incidence of graft failure and recovery is higher impaired graft function (DGF) and other related complications after kidney transplantation. Thus, a more careful evaluation is needed to increase the chance of transplant success.
The kidney viability analysis today includes 3 assessment groups:
– Donor clinical indicators: donor age, primary diseases, history of hypertension, pre-donation creatinine level, occurrence of cardiopulmonary resuscitation (CPR) and hypotension, all closely related to DGF after kidney transplantation (in this work the Kidney Donor was used Profile Index (KDPI).
– Histopathological evaluation of the donor kidney: evaluates chronic changes in the donor and possible acute injuries related to ischemia (in this study, the Remuzzi Scoring System was used)
– Evaluation of Hypothermic Mechanical Perfusion (HMP): with criteria for Terminal pressure (P), flow (F) and resistance index (IR).
The results could indicate that in addition to the donor score, the Remuzzi score and the acute kidney injury score being independent risk factors for the occurrence of DGF (factors already verified in other studies), it was also verified that the donor score, Remuzzi score and HMP parameters were correlated with each other. So that combined they can not only assess the quality of the donor kidney, but also more accurately predict the occurrence of DGF.
Impact factor is an attempt to measure the impact that a publication has by counting the times that its articles have been cited, establishing a rank with those that presented the highest number of citations.
As there is increasing gap between demon and supply of donor organ and number of donor organ are being discarded and suboptimal donor organ being transplanted to recipient leading to DGF/PNF and long term graft loss.
This retrospective single center study perform to formulate optimum tool to asses the organ quality to optimize its use.
They use donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters (flow and resistance index) to assess the organ quality.
Each of these score was correlated with occurrence of DGF when studied independently but when these parameters were combined all together resulted in increase in ROC score and increased positive predictive value.
Further prospective RCTs will be require to validate these findings.
What is meant by the journal impact factor?
Journal Impact Factor is a scientometric index calculated by clarivate that reflect the yearly mean number of citations of articles published in last two years in a given journal, as an indexed by clarivate’s Web of science.
Journal with high impact factor values are given the status of being more important or carry more prestige in their respective field.
This is a retrospective study done in a single center to evaluate the kidney biopsy histopathology features, HMP parameters and clinical characteristics like hypertension.
Donor score taken s.Cr pre-donation, history of hypertension, Remuzzi score, taken to evaluate the quality of donor kidney and AIN, ATI, RI 3 were taken as risk factor for DGF occurrence, the kidney donor profile index scone was taken as estimate for graft failure.
The impact factor is to measure the frequency with which the average article in a journal has been cited in a particular year.
Introduction
· The high incidence of graft loss, DGF, and complications, donor kidneys need more accurate assessment
· The donor scoring system includes: 1) donor’s age 2) primary diseases 3) HTN 4) pre-donation creatinine level, 5) history of CPR 6) hypotension
· Pre-implantation biopsy may evaluate the potential chronic changes in renal structure, and assess ischemic injury in the donated kidney
· Hypothermic mechanical perfusion reduce DGF, and used to give agents to minimize ischemia/reperfusion injury
Materials and methods
· This is a retrospective study of 181 donors and 333 recipients of a single kidney transplant center
· Exclusion criteria: recipients that were less than 16 years old, re-transplantation patients, dual kidney and multi-organ transplants recipients
Discussion
· Organ shortage led to use marginal kidneys which increased the risk of DGF
· DGF is AKI that could be due to CPR or hypotension during the donation process
· Donor score, Remuzzi score and ATI all were the independence risk factor of DGF
· The Kidney Donor Profile Index (KDPI) is a score that estimates the risk of graft failure
· donor score, donation kidney Remuzzi score and HMP parameters all together may evaluate the quality of donor kidney, and predict the occurrence of DGF
· there was no correlation between ATI and HMP parameters
Conclusion
· clinical characteristics, biopsy histopathology features and HMP parameters, all collectively may provide a new wat to evaluate donor kidneys
· Donor score, history of HTN, sCr pre-donation, Remuzzi score, AN, ATI and HMP RI 3 were risk factors of DGF occurrence
What is meant by the journal impact factor?
It is a measure of the frequency with which the average article in a journal has been cited in a particular year. It is used to measure the importance or rank of a journal by calculating the times its articles are cited
Introduction : donor scoring system includes donor’s age, primary diseases, history of HTN, pre-donation creatinine level, post CPR and hypotension, all can cause DGF
Histopathological evaluation of the donor kidney via biopsy is an important component of the comprehensive evaluation, especially for ECD evaluation
Hypothermic mechanical perfusion (HMP) has been shown to mitigate DGF by removing
residual renal microthrombi, dredging renal micro vessels and provide measures to assess renal function
Aim In this study, the correlation of donor patient parameters, kidney pre-implant pathology Remuzzi scores and HMP parameters were analyzed collectively, to select the best donor easily.
Method:
181 donors and 333 recipients
single kidney transplant center
January 2018 to September 2019,
Exclusion criteria: recipients < 16 years old, re-transplantation patients, dual kidney and multi-organ
Immunosuppression
triple immunosuppressive regimen with calcineurin inhibitors (CNIs), mycophenolate sodium and prednisone
Results
All recipients in this cohort received DCD organs.
The study covered 181 cases of donation, including 99 cases of standard criteria donation (54.7%) and 82 cases of ECD (45.3%)
Donor score is significantly correlated with HMP flow or HMP RI (p < 0.001) . A strong correlation also exists between either the donor score or HMP parameters and the Remuzzi score of donor kidneys
the patients who received a kidney from an individual with a high donor score had a higher risk of developing DGF
donor score, Remuzzi score and ATI still were independent risk factors for DGF
Method : single centre retrospective cohort analysis of hypothermic machine perfused kidneys (RM3 Waters Medical System, US) transplanted from March 2012 to April 2018 versus cold storage only
case controls were matched on 1:1 basis according to graft type (DBD or DCD), donor age, cold ischaemic time (CIT), and number of Human Leukocyte Antigen (HLA) mismatches between donor and recipients.
Result :
No statistical difference was observed between the HMP and CS group baseline characteristics: mean recipient’s age, cause of kidney failure, numbers of grafts from DCD and DBD donors, number of HLA mismatches between donor and recipient, donor’s age and CIT
The DCD kidneys that developed DGF in the HMP group were 5/12 versus 10/12 in the CS control cohort
The patients receiving grafts with subsequent DGF had higher length of hospital stay
The RI decreased statistically significantly during HMP:
Conclusion :
the hypothermic machine perfusion offers an advantage in deceased donor renal transplantation
of high risk kidneys, since it reduces significantly DGF rates and is associated with higher posttransplant eGFRs
Introduction
most deceased donation donors are considered
extended criteria donors (ECD); while a patient may
receive an organ, its quality and likelihood for full
engraftment cannot be guaranteed. This results in a
high incidence of graft failure, delayed recovery of graft
function (DGF) and other related complications after
kidney transplantation. Therefore, the quality of
donor kidneys and their suitability for transplantation
need to be more accurately assessed in order to
increase the likelihood of successful engraftment
Definitions
DGF was defined as dialysis required in the first 7 days
after transplantation. Recipients receiving dialysis during the first week after renal transplantation for the reasons of acute rejection, or surgical complication were
not regarded as DGF. ECDs were defined as donors
aged 60 years and older, or those aged 50–59 years
with at least two of the following conditions: cerebrovascular cause of death, terminal creatinine >1.5 mg/dL and/or hypertension.
Materials and methods
Study cohort and ethics statement
We retrospectively studied the records of 181 donors
and 333 recipients of a single kidney transplant from
January 2018 to September 2019.
We excluded recipients that were less than 16 years old, re-transplantation patients, dual kidney and multi-organ transplants recipients.
Data collection
Donor individual characteristics were collected including: age, sex, cause of death, serum creatinine (sCr) levels prior to organ recovery, history of hypertension, incidence of CPR and hypotension duration, organs cold ischemia time and warm ischemia time and ECD.
The donor scoring system
included the donor’s age, primary disease, sCr levels prior to organ recovery, history of hypertension, CPR incidence and hypotension duration.
Machine perfusion
All donation after cardiac death (DCD) kidneys included
in our study were perfused in situ and preserved by an
HMP device
Pre-implantation biopsy evaluation
Two biopsies were obtained for each donation kidney.
All biopsies were performed preimplantation, but the histopathologic diagnosis was determined after transplantation
Immunosuppression
All recipients were given a triple immunosuppressive
regimen with calcineurin inhibitors (CNIs), entericcoated mycophenolate sodium and prednisone.
In conclusion
*both acute and chronic lesions of donation kidney play an important role in the occurrence of DGF
*The pre-implantation biopsy is frequently performed and serves as another important tool for evaluating the kidney lesions, particularly in cases of ECD
*HMP enables the assessment of graft viability and quality pre-implantation through tracking measures of perfusate flow rate and vascular resistance
*study provides a new way to comprehensively evaluate donor kidneys by combining
clinical characteristics, biopsy histopathology features
and HMP parameters.
1. Please provide a summary of this article
2. What is meant by the journal impact factor?
Methods:
This is a retrospective study was conducted in China aiming to find out risk factors for delayed graft function and build a system assessing the pre-donation quality of the kidney.
333 DCD renal transplants were included in this study from January 2018 till September 2019.
Many statistical methods are used to investigate the potential risk factors.
Findings:
13.8% (46/333) recipients developed DGF.
Independent risk factors of DGF include the following: Donor clinical scores (age, primary disease, hypertension, hypotension, Creatinine level pre-donation, CRP) Remmuzzi score, HMP flow and resistance index and ATI score.
Conclusion:
More accurate estimation of DGF risk after kidney DCD transplantation is expected with combined donor clinical score, Remuzzi score and HMP data.
Limitations of the study:
1- Retrospective.
2- Small sample size.
3- Same race and ethnicity of participants.
4- Single center study.
Evidence Level: III
Journal Impact Factor:
IF is an indicator of the importance of a journal in its field and the frequency of a journal has been cited in a certain time.
IF is calculated via the following formula:
No of citations in the JCR (Journal Citation Report) / No of articles published in the previous 2 years.
For example, Nature Journal had an impact factor of 41.577 in 2017.
IF= Citations 2017/ (publications 2015+ publications 2016)
Due to the current high demand for transplant tissue, an increasing proportion of kidney donors are considered extended criteria donors, which results in a higher incidence of delayed graft function (DGF) in organ recipients. Therefore, it is important to fully investigate the risk factors of DGF, and establish a prediction system to assess donor kidney quality before transplantation.
The donor scoring system includes donor’s age, primary diseases, history of hypertension, pre-donation creatinine level, occurrence of cardiopulmonary resuscitation (CPR) and hypotension, all of which are closely related to DGF after kidney transplantation .
This scoring system based on DGF risk factor analysis has been shown to objectively evaluate the quality of donor kidneys.
Histopathological evaluation of the donor kidney via biopsy is an important component of the comprehensive evaluation, especially for ECD evaluation .
The pre-implantation biopsy is performed not only to evaluate the potential chronic changes in renal structure, but also to assess ischemic injury in the donated kidney .
Hypothermic mechanical perfusion (HMP) has been shown to mitigate DGF by removing residual renal microthrombi, dredging renal micro vessels and provide measures to assess renal function .
It provides a more optimal environment while the organ awaits transplantation, and can be exposed to variable temperatures and even treated with agents to minimize ischemia/reperfusion injury and decrease DGF .
It is important to investigate the risk factors of DGF and establish a comprehensive predictive system to assess donor kidney quality before transplantation on the occurrence of DGF. In this study, the correlation of donor patient parameters, kidney pre-implant pathology Remuzzi scores and HMP parameters were analyzed collectively, instead of individually, to enrich the comprehensive evaluation of donor kidney quality.
The donor scoring system
The donor scoring system included the donor’s age, primary disease, sCr levels prior to organ recovery, history of hypertension, CPR incidence and hypotension duration.
Machine perfusion
All donation after cardiac death (DCD) kidneys included in our study were perfused in situ and preserved by an HMP device (LifePort, Organ Recovery Systems).
Pre-implantation biopsy evaluation
Two biopsies were obtained for each donation kidney.
Immunosuppression
All recipients were given a triple immunosuppressive regimen with calcineurin inhibitors (CNIs), entericcoated mycophenolate and prednisone.
All the recipients were treated with rabbit anti-thymocyte globulin at a dosage of 1.25–1.50 mg/kg/day as induction therapy during the surgery, and a total of 4–6 days after kidney transplantation.
Definitions
DGF was defined as dialysis required in the first 7 days after transplantation. Recipients receiving dialysis during the first week after renal transplantation for the reasons of acute rejection, or surgical complication were not regarded as DGF.
ECDs were defined as donors
>>> The pre-implantation biopsy is frequently performed and serves as another important tool for evaluating the kidney lesions, particularly in cases of ECD .
To better quantitate histopathologic features, the Remuzzi scoring system was adapted to assess chronic lesions of donation kidneys.
HMP was usually used to remove residual thrombi from the microcirculation, in order to improve early function and graft survival Furthermore, HMP enables the assessment of graft viability and quality pre-implantation through tracking measures of perfusate flow rate and vascular resistance.
Combining donor score, Remuzzi score, ATI and HMP RI together provides the most accurate prediction of DGF.
Introduction:
The article was about the comprehensive assessment of deceased donor kidneys with clinical characteristics pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters are highly predictive of delayed graft function. Over the years living donors were the most used donors for transplantation but over the years this has changed with the introduction of marginal kidneys and extended criteria and using organs from DCD and DBD. For transplantation to be considered a success there must not only be a good surgical outcome but that the graft or allograft becomes functional. That is why kidney donors must be examined and prepared based on protocols. To know if the kidneys are suitable an important tool that can be used in most instances is the use of kidney biopsy. That is important to identify chronic kidney changes and other ischemic changes.
Aim of the study:
The aim of the study was to investigate the risk factors for DGF and to establish a comprehensive predictive system to assess the donor’s kidney before transplantation on the occurrence of DGF.
The study was conducted at the Kidney transplant department at the First Affiliated Hospital of Xi’an Jiaotong University. Approval was given by the institute’s ethical board.
The population size used was about 181 donors after cardiac death and transplantation recipients were 333 from a period of January 2018 to September 2019,
Factors to consider to predict kidney DGF
1) The donor’s age
2) Baseline pathology
3) If there was the presence of HTN
4) Pre-transplantation creatinine level
5) If there was CPR and hypotension and duration of hypotension.
6) Kidney biopsy to evaluate the functionalities of the kidneys
The result that was obtained was:
1) Before kidney retrieval the mean serum creatinine level was about 113.0+/- 78.7 mmol/L
2) It was noted that the mean warm and cold ischemia was about 5.1 and 8.7 hours respectively
3) The follow-up after-care transplantation was about 297 +/- 110 days and was noted that the appearance of DGF was in about 46 of the recipients
4) Two fundamental scoring were used the clinical score and the Remuzzi score. So it was noted that the higher the scores the higher the risk to develop DGF.
5) It was also observed that there was a correlation between the Remuzzi score and the arteriole narrowing and its association with DGF.
Conclusion:
To have a better renal outcome it is wise to do a combination of assessments that include clinical, histological, and using HMP. Is so doing together they will provide a more accurate prediction of DGF in transplant patients and measures can be taken to address any problems.
What journal impact factors?
The journal impact factor is a method that is used as an indicator of the importance of a journal to its field. It is a measure that reflects the average number of citations to articles published in a journal, book, thesis, project, etc. It evaluates the importance of a journal within its field and measures the frequency with which the average articles in a journal have been cited in a particular time period. The impact factor can be calculated after completing a minimal of 3 years of publications. It only applies to journals.
INTRODUCTION
· extended criteria deceased donors have high incidence of graft failure, delayed recovery of graft function (DGF) and other related complications after kidney transplantation
· The donor scoring system includes donor’s age, primary diseases, history of HTN, pre-donation creatinine level, post CPR and hypotension, all of which are related to DGF
· pre-implantation biopsy can evaluate the potential chronic changes in renal structure, and assess ischemic injury in the donated kidney
· Hypothermic mechanical perfusion reduces DGF by providing more optimal environment.
· It is crucial to identify risk factors of DGF, because it may increase risk of rejection, increase hospitalization time and cost, and may reduce survival of graft.
· In this study, the correlation of donor patient parameters, kidney pre-implant pathology Remuzzi scores and HMP parameters were analyzed collectively, to select the best donor easily.
Materials and methods
· the records of 181 donors and 333 recipients of a single kidney transplant center from January 2018 to September 2019, were reviewed.
· Exclusion criteria: recipients < 16 years old, re-transplantation patients, dual kidney and multi-organ transplants recipients
· All DCD kidneys included in this study were perfused in situ and preserved by an HMP device
· Pre-implantation Two biopsies were obtained for each donation kidney by the transplant surgeon using a 16G Bard needle
· histopathologic diagnosis settled after transplantation to avoid potential selection bias
Definitions
· DGF: dialysis required in the first 7 days after transplantation.
· ECDs: donors aged 60 years and older, or those aged 50–59 years with at least two of the following conditions: cerebrovascular cause of death, terminal creatinine >1.5 mg/dL and/or hypertension.
Results
· All recipients in this cohort received DCD organs.
· 181 cases of donation, 54.7% of standard criteria donation and 45.3% of ECD
· The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters were all correlated.
· DGF occurred in 13.8% of cases.
· The mean follow-up time after transplantation was 297.8 ± 110.1 days
· Risk factors of DGF: high donor score, HTN, creatinine, Remuzzi score, Arteriole narrow score, ATI score, The HMP flow index and RI
Conclusions:
· Combination of donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.
What is meant by the journal impact factor?
· Impact factor is commonly used to evaluate the relative importance of a journal within its field and to measure the frequency with which the “average article” in a journal has been cited in a particular time period.
· Journal which publishes more review articles will get highest IFs.
· Journals with higher IFs believed to be more important than those with lower ones.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150161/#:~:text=Journal%20Impact%20Factor,V.%20Desai3
Owing to the increasing no of donors who are considered ECD, wide range of marginal donors and patients with compromised kidney function are accepted as ECD, therefore the risk of DGF is mounting with its known consequences of increasing the acute cellular rejection incidence and adverse long term death censored allograft survival. Hence, DGF is the major impediment for successful allograft transplantation. This prospective study was conducted to answer the question of how to predict the occurrence of DGF based on the different parameters that formulate the platform for enhancing the selection of the allograft.
DCD is associated with 50% incidence of DGF. Which is a sheer no. that adversely affect the DCD allograft processing.
The parameters researched to predict the occurrence of DGF include:
1) Clinical condition of the patients, DCD allograft donor. That is, age, sex comorbidities, hypertension, Diabetes, creatinine level,CPR, cause of death, occurrence of hypotension and duration
2} HMP parameters which evaluate the health status of the allograft. stable pressure, flow and resistive index were recorded.
3}Histopathology classification preimplantation, Remuzzi scores,to stratify chronic changes including glomerulosclerosis,arterial lumen stenosis, tubular atrophy and interstitial fibrosis. Similarly, ATI was also assessed.
181 donors all of them with DCD were enrolled, 99 of SCD and 82 of ECD with 331 recipients.
DGF was diagnosed when dialysis was indicated in the first week post transplantation with exclusion of acute rejection.
All patients were followed for a minimum of 3 months.
DGF was reported in 46 patients.
The risk of DGF was soaring in recipients with allograft from individuals with high donor score, particularly presence of hypertension, elevated terminal creatinine, Remuzzi score was predictive as well, distinctly the higher ATN score and the arteriolar narrowing.
RI of more than 0.3 mm Hg/ml/min is correlated with increased risk of DGF.
Those parameters were independent risk factors of escalated risk of DGF, which is indicative of importance of all the parameters to be adopted in order to mitigate the risk of DGF.
Introduction:
Most deceased donation donors are considered as extended criteria donors (ECD) due to the current high demand for transplant tissue which results in a higher incidence of delayed graft function (DGF) in organ recipients. Therefore, it is important to fully investigate the risk factors of DGF, and establish a prediction system to assess donor kidney quality before transplantation.
Methods:
They retrospectively studied the records of 181 donors and 333 recipients of a single kidney transplant center from January 2018 to September 2019.
They excluded recipients that were less than 16 years old, re-transplantation
patients, dual kidney and multi-organ transplants recipients.
Data collection:
Donor individual characteristics were collected including: age, sex, cause of death, serum creatinine (sCr) levels prior to organ recovery, history of hypertension,incidence of CPR and hypotension duration, organs cold ischemia time and warm ischemia time and ECD.
Recipient characteristics at the time of transplant
including: age, sex, number of previous kidney transplants, current level of panel reactive antibodies, number of human leukocyte antigen mismatches, DGF and
recipients following up time.
All donation after cardiac death (DCD) kidneys were perfused in situ and preserved by anHMP device.
All recipients were given a triple immunosuppressive regimen with calcineurin inhibitors (CNIs), enteric-coated mycophenolate sodium and prednisone.
DGF was defined as dialysis required in the first 7 days after transplantation.
Results:
46 recipients developed DGF postoperatively, with an incidence of 13.8% (46/333). Multivariate logistic regression analysis of the kidney transplants revealed that the independent risk factors of DGF occurrence post-transplantation included donor score (OR ¼ 1.12, 95% CI 1.06–1.19, p < 0.001), Remuzzi score (OR ¼ 1.21, 95% CI 1.02–1.43, p ¼ 0.029) and acute tubular injury (ATI) score (OR ¼ 4.72, 95% CI 2.32–9.60, p < 0.001).
Conclusion:
This study evaluated donor kidneys by combining clinical characteristics, biopsy histopathology features and HMP parameters. Donor score, donation kidney Remuzzi score and HMP parameters combined together can not only evaluate the
quality of donor kidney, but also more accurately predict the occurrence of DGF.
Introduction
This retrospective study was done to investigate the risk factors of DGF, and establish a prediction system to assess organ quality before transplantation from deceased donors.
DGF increases the incidence of acute rejection, increase hospitalization time and costs, affect the confidence of patients in recovery, contribute to an increased risk for developing chronic kidney disease and reduce the survival rate of transplanted kidney.
☆assessment of a donor kidney includes
– clinical evaluation of donor patients.
– visual observation after donor kidney acquisition.
-assessment of mechanical perfusion indicators.
Hypothermic mechanical perfusion (HMP) has been shown to mitigate DGF by removing residual renal microthrombi, dredging renal micro vessels and provide measures to assess renal function.
– donor scoring system which includes donor’s characteristics ,and medical conditions (age, primary diseases, history of hypertension, pre-donation creatinine level, occurrence of cardiopulmonary resuscitation (CPR) and hypo-tension).
-Histopathological evaluation by biopsy to evaluate chronic changes in renal structure, and ischemic injury in the donated kidney.
☆Materials and methods
-retrospective study of 181 donors and 333 recipients of a single kidney transplant at our center .
-Recipient characteristics data collected at the time of transplant, level of PRA,HLA mismatches, DGF and recipients following up time.
-Donor individual characteristics were collected donor clinical scores was developed to predict graft performance.
*donor scoring system
The donor scoring system included the donor’s age, primary disease, sCr levels prior to organ recovery, history of hypertension, CPR incidence and hypotension duration.
-All DCD kidneys included in the study were perfused in situ and preserved by an HMP device.
-Pre-implantation biopsies were performed
Based on Remuzzi, the donor renal glomerulo-sclerosis, tubular atrophy, interstitial fibrosis and arterial lumen stenosis were each assessed by a pathologist as 0–3 points.
-All recipients were given a triple immunosuppressive regimen
▪︎Results and discussion
The study covered 181 cases of DCD, including 99 cases of standard criteria donation, and 82 cases of ECD .
clinical scores were distributed as follows: 105 cases (31.5%) were less than or equal to 5; 179 cases (53.8%) were in the range of 6 and 15; 49 cases (14.7%) were in the range of 16 and 30; the highest score was 27.
*Risk factors of DGF
– patients who received a kidney from an individual with a high donor score, especially if there was a history of hypertension ,high sCr before procurement were at higher risk for DGF .
-Remuzzi score ,ATI and AN score were also associated with a higher risk of DGF.
-The HMP flow index and RI were also correlated with development of DGF after kidney transplantation, especially RI >0.3 mmHg/(mL/min)
-donor score, Remuzzi score and ATI still were independent risk factors for DGF.
-predicted DGF was increased when fitting the key variables (Donor score, Remuzzi score, ATI and RI) together.
-The sensitivity and specificity of predicting DGF were 0.804 and 0.805, respectively.
▪︎conclusion
the study provides a new way to comprehensively evaluate donor kidneys by combining clinical characteristics, biopsy histopathology features and HMP parameters.
Donor score, Remuzzi score and HMP parameters were correlated with each other.
In particular, donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI >3 were risk factors of DGF.
What is meant by the journal impact factor
Impact factor is commonly used to evaluate the relative importance of a journal within its field and to measure the frequency with which the “average article” in a journal has been cited in a particular time period. Journal which publishes more review articles will get highest IFs. Journals with higher IFs believed to be more important than those with lower ones.
According to Eugene Garfield “impact simply reflects the ability of the journals and editors to attract the best paper available.” Journal which publishes more review articles will get maximum IFs.
Impact factor can be calculated after completing the minimum of 3 years of publication; for that reason journal IF cannot be calculated for new journals
It is retrospective study involved 181 donors and 333 recipients of a single kidney transplant at from January 2018 to September 2019.
– DGF refers to the acute kidney injury which caused by CPR or hypotension during the donation process and could be reflected by high sCr before donation .
-The donor score, Remuzzi score and ATI all were the independence risk factor of DGF.
-The Kidney Donor Profile Index (KDPI) is a score that estimates the risk of graft failure
– The donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI ˃3 were risk factors of DGF occurrence.
-The donor score, Remuzzi score and ATI were independent risk factors for DGF occurrence post-transplantation, especially ATI.
-Kidneys from donors that are elderly, hypertensive or those with renal dysfunction could have chronic lesions such as glomerulosclerosis, tubular atrophy, interstitial fibrosis and arterial sclerosis.Diabetes can lead to hyaline arterioles and hypertrophy of the basement membrane.
-The donor score, donation kidney Remuzzi score and HMP parameters
combined together can not only evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF.
The Impact factor (IF) or journal impact factor (JIF) of an academic journal is a sciento-metric index calculated by Clarivate that reflects the yearly mean number of citations of articles published in the last two years in a given journal, as indexed by Clarivate’s Web of Science.
The impact factor is a way of evaluating the impact of a journal in its field by measuring the average frequency of cited articles in that journal in a particular period (the previous two years).
Summary of the article:
With the trial of extending the donor pool, we need to determine the factors influencing graft function to predict DGF risk. evaluating donors by donor scoring system that includes donor age, primary diseases, history of HT, pre-donation, Scr level, and occurrence of CPR&hypotention is essential for predicting DGF, which will increase the burden of AKI and influence patients’ survival and mortality.
In this retrospective study from china evaluating 181 donors (333 recipients) retrospectively, the Remmuzi score, HMP parameters and donor parameters were evaluated collectively.
In the study performed between 01/2018-09/2019, dual kidney, multiple organ recipients and <16 years old were excluded.
Age, sex, cause of death, Scr before organ receiving, the incidence of CPR & duration of hypotension, and cold/warm ischemia times data were collected.
As shown in table 1, donors had a mean age of 50.8, the primary disease was mostly cerebral haemorrhage (%82). 82 had ECD criteria (age>60 or 50-59 with CVA, terminal Scr>1.5 mg/dl and/or HT).
The evaluation revealed that donor score, Remmuzi score (%33 increase) and ATI (5.38 times) were independent risk factors for increased DGF.
——
As adapted from figure 1, we see that 84 had a Remmuzi score of (4-6) which may be more suitable for dual kidney rather than single kidney donation.
Summary of the article
Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre- implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function.
This is a single center retrospective study, in the kidney center- Hospital of Xi’an Jiaotong University,from January 2018 to September 2019. 181 donors and 333 recipients were included in the study.
The comprehensive evaluation of the donor kidney as a predictor of DGF:
a) Donor’s age.
b) Primary diseases.
c) History of hypertension.
d) Pre-donation creatinine level.
e) Incidence of cardiopulmonary resuscitation (CPR) and duration of hypotension.
f) Pre-implantation biopsy evaluation; Histopathological evaluation of the donor kidney via biopsy.
1) immunofluorescence staining including IgA, IgM, IgG, C3, C1q, fibrin-related antigen.
2) Tissue fixed in formaldehyde, embedded in paraffin, sectioned and stained for hematoxylin and eosin, periodic acid-Schiff’s, Masson’s trichrome and silver methenamine.
3) Based on Remuzzi, the donor renal glomerulo- sclerosis, tubular atrophy, interstitial fibrosis and arterial lumen stenosis were each assessed by a pathologist as 0–3 points according to the degree of lesion.
g) Technique of organ preservation; Hypothermic mechanical perfusion (HMP) has been shown to be beneficial:
1) It mitigates DGF by removing residual renal microthrombi.
2) Dredging renal micro vessels and provide measures to assess renal function.
3) It provides a more optimal environment while the organ awaits transplantation.
4) Can be exposed to variable temperatures.
5) Can be treated with agents to minimize ischemia/reperfusion injury and decrease DGF.
The study result and outcome
1. The donor score, Remuzzi score and ATI all were the independence risk factor of DGF. This indicates that both acute and chronic lesions of donation kidney play an important role in the occurrence of DGF.
2. The donors’ clinical scores correlated with kidney biopsy histopathology scores.
3. The donor score, donation kidney Remuzzi score and HMP parameters combined together can not only evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF.
4. There was no correlation between ATI and HMP parameters, and there was no statistical correlation between glomerular sclerosis (GS) and HMP parameters.
What is meant by the journal impact factor?
The Impact factor (IF) or journal impact factor (JIF) of an academic journal is a sciento-metric index calculated by Clarivate that reflects the yearly mean number of citations of articles published in the last two years in a given journal, as indexed by Clarivate’s Web of Science.
As a journal-level metric, it is frequently used as a proxy for the relative importance of a journal within its field; journals with higher impact factor values are given status of being more important, or carry more prestige in their respective fields, than those with lower values.
Calculation
The Impact Factor is calculated by dividing the number of citations in the JCR year by the total number of articles published in the two previous years. An Impact Factor of 1.0 means that, on average, the articles published one or two years ago have been cited one time. An Impact Factor of 2.5 means that, on average, the articles published one or two years ago have been cited two and a half times. Citing articles may be from the same journal; most citing articles are from different journals.”
Limitations of the JIF
· Some journals increased the impact factor value by reducing the number of scholarly records.
· Extension of the impact factor to the assessment of journal quality or individual authors is inappropriate.
· Extension of the impact factor to cross-discipline journal comparison is also inappropriate.
· Those who choose to use the impact factor as a comparative tool should be aware of the nature and premise of its derivation and also of its inherent flaws and practical limitations.
That is a good summary. I like that you mention ‘limitations of this article’
Please provide a summary of this article
-Most deceased donation donors are considered extended criteria donor.This results in ahigh incidence of graft failure, delayed recovery of graft function (DGF) and other related complications after kidney transplantation .
-The quality assessment of a donor kidney is a comprehensive
analysis that includes clinical indicators of donor patients before donor kidney acquisition, the visual observation after donor kidney acquisition and the assessment of mechanical perfusion indicators during donor kidney maintenance .
-Histopathological evaluation of the donor kidney via biopsy is an important component of the comprehensive evaluation, especially for ECD evaluation .
– Hypothermic mechanical perfusion (HMP) has been shown to mitigate DGF by removing residual renal microthrombi, dredging renal micro vessels and provide measures to assess renal function.
-It is retrospective study involved 181 donors and 333 recipients of a single kidney transplant at from January 2018 to September 2019.
– DGF refers to the acute kidney injury which caused by CPR or hypotension during the donation process and could be reflected by high sCr before donation .
-The donor score, Remuzzi score and ATI all were the independence risk factor of DGF.
-The Kidney Donor Profile Index (KDPI) is a score that estimates the risk of graft failure
– The donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI ˃3 were risk factors of DGF occurrence.
-The donor score, Remuzzi score and ATI were independent risk factors for DGF occurrence post-transplantation, especially ATI.
-Kidneys from donors that are elderly, hypertensive or those with renal dysfunction could have chronic lesions such as glomerulosclerosis, tubular atrophy, interstitial fibrosis and arterial sclerosis.Diabetes can lead to hyaline arterioles and hypertrophy of the basement membrane.
-The donor score, donation kidney Remuzzi score and HMP parameters
combined together can not only evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF.
What is meant by the journal impact factor?
The impact factor (IF) or journal impact factor (JIF) of an academic journal is a scientometric index that reflects the yearly mean number of citations of articles published in the last two years in a given journal. As a journal-level metric, it is frequently used as a proxy for the relative importance of a journal within its field; journals with higher impact factor values are given the status of being more important than those with lower values.
That is a good summary. I wish you could have highlighted ‘limitations of this article’
Summary
This study is about assessing deceased donor kidneys with respect to clinical characteristics, biopsy histopathology and HMP. All of these are done to prevent DGF since DGF is a significant impactor of risk for acute rejection and increased hospitalization along with increased cost.
Clinical indicators such as donor age, primary disease, history of hypertension, pre-donation creatinine level, CPR history, hypotension are all checked for, since these can be related to the development of DGF post transplant.
HMP plays a major role in preventing DGF by removing residual renal micro thrombi while monitoring renal function. This gives the organ a better chance of preservation while waiting for transplant. The organ is also treated with agents to minimize ischemia or repercussion injury, effecting further decreasing the risk of DGF in the recipient.
Both acute and chronic lesions of the donor kidney impact the occurrence of DGF. KDPI estimates the risk of graft failure. Remuzzi score is used to assess for chronic lesions in the donor kidney. Both of these play a role in estimating DGF risk.
No correlation was found between ATI and HMP parameters. This is because the main lesion site of the kidney was found to be kidney tubule, which does not have much of an impact of microcirculation. MIcrocirculation is affected by HMP.
In conclusion, the study here delineates that DGF occurrence can be predicted from donor score, donation kidney Remuzzi score, and HMP parameters combined together in evaluating the quality of the donor kidney.
I like the scientific contents of your reply. Please type headings and subheadings. And these should be in bold or underline so that it is easier to read.
Summary of the Article
Introduction:
Due to the high demand of organs and the shortage of supply, most countries and transplant centers have opted to increase the organ pool by utilizing DCD donors and ECD donors. Kidneys from ECD donors and DCD donors have increased risk of DGF and graft failure. Therefore, kidneys from DCDs and ECDs need to be evaluated to assess the quality of the organ and risk of DGF. This includes looking at the donor clinical characteristics, histological characteristics of the pre-implant biopsy using the Remuzzi score and hypothermic perfusion parameters including RIs, terminal pressure and flow.
Methodology
This was a retrospective single center survey that looked at 181 donors and 333 recipients of a single kidney transplant from January 2018 to September 2019.
Donor individual characteristics were collected including age, gender, cause of death, terminal serum creatinine, history of HTN, incidence of CPR and hypotension duration, organ cold ischemia time and warm ischemia time.
Recipient characteristics included age, gender, number of previous kidney transplants, PRAs, number of HLA mismatches and DGD
The donor scoring system included the donors age, primary disease, terminal serum Cr, history of HTN, CPR incidence and hypotension duration. The value of the donor clinical score was developed at the same center and validated from a thousand patient cohort.
Machine perfusion
All donation after cardiac death kidneys included in the study were perfused in situ and preserved by an HMP device. The perfusion pressure was initially set at 30-40 mmHg. Terminal pressure, flow and RI were recorded at the end of perfusion, just before transplantation.
Pre-implantation Biopsy Evaluation
The biopsies were performed by the transplant surgeon and sent for IF and light microscopy. Remuzzis method was used to evaluate chronic histopathological changes in the donor kidney and acute tubular injury (ATI) was also assessed.
All recipients received ATG as induction and were on triple immunosuppression.
DGF was defined as dialysis required in the first seven days after transplantation.
ECDs were defined as donors aged 60 years and older or aged 50-59 years with two of the following: history of HTN, serum creatinine more than 1.5 mg/dL or cerebrovascular cause of death.
Both univariate and multivariate analyses were used to analyze the risk factors of DGF occurrence.
Results
All recipients in the study received DCD organs. The mean donor age was 50.8 years; 48 donors (26.5%) of the donors were more than 60 years. the main primary diseases of the donors were cerebral hemorrhage and trauma. The mean terminal serum creatinine before procurement was 113 mmols/L. 115 (63.5%) of the donors had hypertension while 12.7% had received CPR. 333 graft biopsies were performed in the OR before transplantation.
The mean recipient age was 36.2 years.
DGF occurred in 46 (13.8%) cases
Only 1.5% of the grafts had a Remuzzi score of between 7 and 12 and 1.2% had sever ATI
The highest RI was 0.7 mmHg.
Univariate analysis showed that recipients who received a kidney from a donor with a higher donor score had a greater chance of developing DGF especially if there was a history of HTN or high terminal serum Cr.
A higher Remuzzi score was also associated with an increased risk of developing DGF. ATI was highly predictive of DGF. The HMP flow index and RI also correlated with the development of DGF after kidney transplant, especially RI more than 0.3 mmHg.
In the multivariate logistic regression analysis , donor score, Remuzzi score and ATI still were independent risk factors for DGF occurrence. History of HTN, serum Cr before procurement and HMP parameters were not independent risk factors of DGF occurrence.
The ROC analysis showed that the AUC for the five evaluated variables were lower than 80%. However, the AUC increased to 0.89 when all the variables were taken together. the sensitivity and specificity of predicting DGF were 0.804 and 0.805 respectively.
Discussion
It is important to evaluate the donors and quality of organs to predict the risk of DGF to improve graft survival and reduce the length of hospital stay. Donor clinical characteristics, pre-implantation biopsy histopathological scores and HMP parameters can help predict the risk of DGF. The study showed that donor score, HTN, terminal serum Cr, remuzzi score, AN, ATI and HMP RI more than 3 were independent risk factors for DGF.
Combining Remuzzi score, ATI and HMP RI more than 3 provides the most accurate prediction of DGF.
Conclusion
This study provides a new way to comprehensively evaluate donor kidneys by combining clinical characteristics, biopsy histopathology features and HMP parameters
What is meant by the journal Impact Factor
The impact factor is the measure of the frequency with which the average article in a journal has been cited in a particular year. It is used to measure the importance or rank of a journal by calculating the times its articles are cited
That is a good summary. I wish you could have highlighted ‘limitations of this article’
SUMMARY
Introduction
Living donor kidney transplantation used to be the only source of organ until the advent of diseased donor come into the know and which has also been stretched further with the use of what is called marginal kidney or extended criteria donation. A successful kidney transplantation goes beyond successful surgery, but good functional allograft. Hence, there is a need to examine the quality of the kidney donor and their suitability for transplantation with engraftment must be ascertained.
One of the important tools that can be used for this evaluation is the use of pre-implantation biopsy to histologically identify any chronic renal changes or features of ischemic changes
Methods and Materials
Donor scoring system
RESULTS
Conclusion
Donor evaluation is very important to the success outcome of the kidney transplant and donor score, donation Remuzzi score with HMP can both evaluate quality kidney donor and predict occurrence of DGF
Impact factor of journal
I like the scientific contents of your reply.
Introduction:
Using of ECD kidneys are associated with high incidence of graft failure, and DGF, so quality of donor kidney and their suitability of transplantation should be assessed carefully in order to increase the chance of success.
Factor related to DGF;
Donor scoring;
This system scoring used to assess the quality of donor kidney.
HMP; help in improving DGF by;
DGF Sequelle;
So its vitally to assess these risk factors, by establish a predictive system, for kidney quality, so in this study; assessment of donor kidney quality, by;
Material and methods;
Donor scoring system;
The value of this score is to evaluate graft function.
Machine perfusion;
Pre-implantation biopsies;
Immunosupressant;
Definition:
1. DGF defined as dialysis required in the first 7 days after transplantation. but recipients for the reasons of of acute rejection, or surgical complication, not considered as DGF.
2.ECD defined as donor age .60, or 50-60 with at least two of the following; cerebrovascular cause of death, or cr > 1.5 mg/dl and/or hypertension.
Results:
Donor clinical score were as follow;
Rumuzzi score, graft biopsy;
HMP parameters;
Donor score is significantly correlated with HMP flow or HMp RI.
Strong correlation between either donor score or HMP parameter, and the Remuzzi score.
No corellation beteween ATI and HMP parameters.
Risk factors of DGF:
Discussion;
What is meant by the journal impact factor?
IF is the measure of frequency, in which the average article in the journal has been cited in a particular year.
The calculation is based on 2 years period and involve dividing the number of times articles that were cited by the number of articles that are citable
I like the scientific contents of your reply.
unable to Thank
myProf.
Deceased donor transplantation is associated with high risk of DGF due to the increase in the use of marginal kidneys to close the gap between demand and supply, with subsequent increase in the risk of graft failure especially when using DCD kidneys
This is a retrospective study evaluating 333 DCD kidney transplant recipients regarding the correlation between donor clinical scores, histologic (Remuzzi and ATI) scores, resistive index (RI )obtained during hypothermic mechanical perfusion (HMP) and the occurrence of DGF
Results
Conclusions:
What is meant by the journal impact factor?
· IF of ≥ 10 is considered excellent, IF of 3 is considered good, IF or 1 is average
I like the scientific contents of your reply.
The type of the study ;
Retrospective cohort study.
The aim of the study ;
to investigate the risk factors of DGF and establish a comprehensive predictive system to assess donor kidney quality before transplantation on the occurrence of DGF.
The study area;
Department of Kidney Transplant, the First Affiliated Hospital of Xi’an Jiaotong University.
Ethical approval;
was approved by the Institutional Review Board/Ethics of the First Affiliated
Hospital of Xi’an Jiaotong University and was con- ducted in accordance with the principles of Declaration of Helsinki.
Population ;
333 donation after cardiac death kidney transplant recipients
Exclusion criteria;
1-recipients that were less than 16 years old .
2- re-transplantation patients .
3-dual kidney and multi-organ transplants recipients.
Method ;
The cohort consisted of 333 recipients in whom grafts were adequately biopsied in the operating room pretransplant.
All recipients received their first allograft and most were not sensitized.
The mean follow-up time after transplantation was 297.8 ± 110.1 days, with all patients having a minimal follow-up time of 3 months.
The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion (HMP) parameters (flow and resistance index) were all correlated.
Statistical analysis ;
Both univariate and multivariate analyses were used to analyze the risk factors of DGF occurrence. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of variables on DGF post transplant.
Results:
1-DGF occurred in 46 (13.8%) cases.
2-Remuzzi score and HMP parameters were correlated with each other .
3-donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI more than 3 were risk factors of DGF occurrence.
4-donor score, Remuzzi score and ATI were independent risk factors for DGF occurrence post-transplantation, especially ATI.
5-Combining donor score, Remuzzi score, ATI and HMP RI more than or equal 3 together provides the most accurate prediction of DGF.
Limitations ;
1-Single centre study.
2- There was no correlation between ATI and HMP parameters.
Conclusion;
Clinical information, biopsy histopathology and HMP parameters were all indicated for risk assessment of donated kidneys, implying some kind of relationship among them.
What is meant by the journal impact factor?
Is used to evaluate the relative importance of a journal within its field.
The Impact Factor is calculated by dividing the number of citations in the JCR year by the total number of articles published in the two previous years.
The impact factor of 10 or greater is considered an excellent score while 3 is flagged as good and the average score is less than 1.
I like the scientific contents of your reply. Please type headings and subheadings in bold or underline so that it is easier to read.
Transplantation is the best option for ESRD, but we are facing organ shortage & this is increasing in comparison to transplant candidates, so the concept now is to expand the donor criteria to increase the pool of the organs.
There is a higher incidence of DGF in organ recipients from deceased donors, so we need to investigate the risk factors for DGF & to establish a prediction system to donor kidney quality before transplantation.
This is aretrospective study analyzed data from 333 donation after cardiac death kidney transplant recipients, The donor clinical scores, kidney histopathologic Remuzzi scores and hypothermic mechanical perfusion parameters (flow and resistance index) were all correlated.
This study showed that:
1- to evaluate donor kidneys, we have to combine clinical characteristics, biopsy histopathology features and HMP parameters.
2- Donor score, Remuzzi score and HMP parameters were correlated with each other in this study.
3- In particular, donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI of 3 or more were risk factors of DGF occurrence.
4- Furthermore, donor score, Remuzzi score and ATI were independent risk factors for DGF occurrence post-transplantation.
In conclusion of the study, the analysis shows that donor score, donation kidney Remuzzi score and HMP parameters combined together can not only evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF.
>> Impact factor :
– Is an index which indicate the importance of the journal by reflecting the yearly average number of citations to recent articles published in that journal.
– calculated by dividing the number of citations in the measured year by the total number of articles published in the two previous years.
I like the scientific contents of your reply. Please type headings and subheadings in bold or underline so that it is easier to read.
● The donor scoring system that is closely related to DGF after kidney transplantation includes :
* Donor’s age
* Primary diseases
* sCr levels prior to organ recovery
* History of hypertension
* Pre-donation creatinine level,
* Occurrence of (CPR)
* Hypotension
● The pre-implantation biopsy is performed to :
** evaluate the potential chronic changes ** assess ischemic injury
● (HMP) mitigate DGF by
removing residual renal microthrombi, dredging renal micro vessels
provide measures to assess renal function
improve early function and graft survival
assessment of graft viability and quality pre-implantation
● Risk factors of DGF
a high donor score
A high Remuzzi score
ATI
a history of hypertension
a high sCr before procurement
● Increasing use of marginal kidneys rises incidence of DGF
● DGF refers to the acute kidney injury
which caused by CPR
● Kidney Donor Profile Index (KDPI) is a score that estimates the risk of graft failure
● The pre-implantation biopsy is another important tool for evaluating the kidney lesions, particularly in cases of ECD
● Combined together
* donor score
* donation kidney
* Remuzzi score
* HMP parameters
evaluate the quality of donor kidney,and predict the occurrence of DGF.
● limitations
* the donor history of diabetes was very rare in this study
Trauma and cerebral hemorrhage were the major causes.
● The impact factor (IF)
* is a scientometric index calculated by Clarivate
* reflects the yearly mean number of citations of articles published in the last two years in a given journal, as indexed by Clarivate’s Web of Science.
* As a journal-level metric, it is frequently used as a proxy for the relative importance of a journal within its field
* journals with higher impact factor values are given the status of being more important, or carry more prestige in their respective fields, than those with lower values.
* While frequently used by universities and funding bodies to decide on promotion and research proposals, it has come under attack for distorting good scientific practices.
I like the scientific contents of your reply. Please type headings and subheadings. And these should be in bold or underline so that it is easier to read.
Please provide a summary of this article
Due to high demand of kidney donors there is trend to use extended criteria donors in higher numbers . This can lead to higher incidence of DGF. The purpose of this study was to investigate the risk factors of DGF, and establish a prediction system to assess donor kidney quality before transplantation.
Methodology
This was a retrospective study in which 333 recipients were included who had donation from DCD. To identify the risk factors of DGF , univariate and multivariate analysis was used. ROC curves were used to analyze the predictive value of variables on DGF post transplant.
Results
The following parameters were co related-
Remuzzi score
HMP- Flow and RI
Histology
Incidence of DGF was 13.8%.
Independent risk factors for DGF included-
Donor score (OR ¼ 1.12, 95% CI 1.06–1.19, p < 0.001)
Remuzzi score (OR ¼ 1.21, 95% CI 1.02–1.43, p ¼ 0.029)
Acute tubular injury (ATI) score (OR ¼ 4.72, 95% CI 2.32–9.60, p < 0.001).
Prediction of DGF with ROC curve showed the area under the curve was increased to 0.89 when all variables were considered together
Conclusion.
Combination of donor clinical information, HMP parameters and kidney pre-implant histopathology can provide more accurate prediction of DGF occurrence post-transplantation than any of the measures alone
What is meant by the journal impact factor?
The impact factor is the tool to assess the importance of a journal and it is based on the number of citations to the article of this journal during specific time period. It calculated by ratio of the number of citations a journal receives in last 2years to the number of publications of that journal in last 2 years. Cites/doc (2 years).
The article from a journal can used as citation in different books , dissertation and presentations. New journal will not have impact factor in first 2 years. So they may not have impact factor in first 2 years . This can lead to bias .
LEVEL OF EVIDENCE 111
That is a good summary.
1. Please provide a summary of this article
Introduction
A large portion of kidney donors are regarded as ECD due to the increased demand for transplant organs. This resulted in a higher incidence of DGF in the recipients & thus dictated the need to assess the risk factors of DGF, & find a prediction tool for the assessment of the donor kidney quality.
The study
Population
The author retrospectively studied the records of 181 donors & 333 recipients of a SKT from Jan 2018 to Sep 2019.
Exclusion criteria:
Recipients < 16 years old
Re-TX patients
DKT
Multi-organ TXs recipients.
Methods
Both univariate & multivariate analyses used to analyze the risk factors of DGF.
ROC curves used to analyze the predictive value of variables on DGF post-transplant.
The donor scoring system
Included:
Donor’s age
Primary disease
Serum Cr before organ recovery
H/O HTN
CPR incidence & hypotension duration.
Machine perfusion
All DCD kidneys were perfused in situ & preserved by an HMP device.
Immunosuppression
All recipients were given a triple IS regimen (CNIs, Myfortic, & prednisone.
rATG was given to all recipients as induction therapy during the surgery, & a total of 4–6 days after TX.
Results:
All the following were correlated:
Donor clinical scores
Kidney histopathologic Remuzzi scores
HMP parameters (flow & resistance index).
DGF occurred in 46 recipients postoperatively (( incidence 13.8% (46/333)).
Multivariate logistic regression analysis of the kidney TXs showed that the independent risk factors of post-TX DGF included:
Donor score (p<0.001)
Remuzzi score (p=0.029)
ATI score (p<0.001).
Prediction of DGF with ROC curve showed that the AUC was increased to 0.89 when all variables (donor score, Remuzzi score, ATI score & HMP resistance index) were taken together.
Discussion
DGF is increasing with the increase of suboptimal organs.
The study showed that donor score, Remuzzi score & ATI all were the independence risk factor of DGF, indicating that both acute & chronic lesions of donation kidney are playing a role.
The KDPI score estimates the risk of graft failure.
Based on KDPI score combined with donors’ actual situation in China, the authors consider donor age, CVD cause of death, H/O HTN, serum Cr before kidney procurement, hypotension & CPR incidence as a suitable donor evaluation system.
The Remuzzi scoring system was used to assess chronic lesions of donation kidneys on biopsies.
HMP used to remove residual thrombi to improve early function & graft survival.
The combined donor score, Remuzzi score & HMP parameters not only assess the quality of donor kidney, but also more accurately predict the occurrence of DGF.
More TX centers started to thoroughly assess the donor kidney to ensure a more safe & effective use of the organs; ideally, kidneys will be neither wasted nor used in poor condition.
There was no correlation between ATI & HMP parameters.
There was no correlation between GS & HMP parameters.
Trauma (43.1%) & cerebral hemorrhage (45.3%) were the major causes of death.
Conclusions:
Combination of donor score, kidney pre-implant histopathology & HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.
=================================
2. What is meant by the journal impact factor?
1. It is a term that is used to indicate the importance of a journal to its field.
2. The impact factor of a journal is a reflection of the average number of citations to articles published in journals, books, thesis, project reports, newspapers, conference/seminar proceedings, documents published in internet, notes, & any other approved documents.
3. So, it has nothing to do with the factors like quality of peer review process & quality of content of the journal.
4. IF can be calculated after completing a minimum of 3 years of publication; the journal with the highest IF is the one that published the most commonly cited articles over a 2-year period.
5. The IF applies only to journals, not to the articles or scientists.
6. The IF of a journal is calculated by the formula:
2012 impact factor =A/B
A=number of times articles published in 2010 & 2011 were cited by indexed journals during 2012.
B = total number of citable items like articles & reviews published by that journal in 2010 & 2011.
Reference
Mohit Sharma.Journal Impact Factor: Its Use, Significance and Limitations. World Journal of Nuclear Medicine/Vol 13/Issue 2/May 2014
That is a good summary.
Deceased donation donors are considered extended criteria donors (ECD); while a patient may receive an organ, its quality and likelihood of completion cannot be guaranteed. Therefore, the quality of the donor’s kidneys and their suitability for transplantation need to be more accurately assessed. For example, to increase the likelihood of successful engraftment.
The quality assessment of a donor’s kidney:
Includes clinical indicators of donor patients before donor kidney acquisition, the visual observation after donor kidney acquisition, and the evaluation of mechanical perfusion indicators during donor kidney maintenance
The donor scoring system includes the age, primary diseases, history of hypertension, pre-donation creatinine level, the occurrence of cardiopulmonary resuscitation (CPR), and hypotension, all of which are closely related to DGF after kidney transplantation.
This scoring system based on DGF risk factor analysis has been shown to evaluate the donor’s kidneys’ quality objectively.
Histopathological evaluation of the donor’s kidney via biopsy is an essential component of the comprehensive evaluation, especially for ECD evaluation
retrospectively studied the records of 181 donors and 333 recipients of a single kidney transplant at (the Department of Kidney Transplant, excluded recipients that were less than 16 years old, re-transplantation patients, dual kidney and multi-organ transplants recipients
The donor scoring system included: the donor’s age, primary disease, sCr levels before organ recovery, history of hypertension, CPR incidence, and hypotension duration.
Machine perfusion: All donation after cardiac death (DCD) kidneys included in our study were perfused in situ and preserved by an HMP device (LifePort, Organ Recovery Systems.
Pre-implantation biopsy evaluation: Pre-implantation biopsies were performed by the transplant surgeon using a 16G Bard needle. Two biopsies were obtained for each kidney donation.
Immunosuppression: All recipients were given a triple immunosuppressive regimen with calcineurin inhibitors (CNIs), enteric-coated mycophenolate sodium (EC-MPS; Myfortic, Novartis Pharma, Basel, Switzerland), and prednisone.
Definitions: DGF was defined as dialysis required in the first seven days after transplantation.
Statistical analysis: Data were analyzed by SPSSVR version 17.0.
Results
Cohort description:
The study covered 181 cases of donation, including 99 cases of standard criteria assistance (54.7%) and 82 cases of ECD (45.3%).
The mean donor age was 50.8 ± 12.5 years (range 16–73 years); 48 donors (26.5%) were >_60 years of age.
The major primary diseases of donors were cerebral hemorrhage (45.3%) and trauma (43.1%).
Donors’ mean terminal sCr concentration before procurement was 113.0 ± 78.7 mmol/L.
The mean warm and cold ischemia times were 5.1 ± 2.2 min and 8.7 ± 3.4 h, respectively.
DGF occurred in 46 (13.8%) cases.
Distribution of clinical donor score, biopsy pathology score, and HMP parameters:
The distribution of graft biopsy pathology is based on the Remuzzi score. Two hundred forty-four grafts (70.2%) scored 0–3, 84 grafts (25.2%) scored 4–6, and only five grafts (1.5%) were in the range of 7 and 12 (the highest score was 8).
Indices of flow and resistance based on HMP parameters of most grafts (309 cases, 92.8%) were more than 80 mL/min, and the lowest flow parameter was 48 mL/min.
The resistance index of most cases (310/333; 93.1%) was less than 0.4 mmHg/(mL/min), and the highest resistance index was 0.70 mmHg/(mL/min).
A strong correlation also exists between either the donor score or HMP parameters and the Remuzzi score of the donor’s kidneys
Risk factors of DGF:
1-donor score
2- Remuzzi score
3- Arteriole’s narrow (AN) score
Predictive value of the composite parameters for DGF:
Co-evaluation of DGF occurrence was based on clinical donor status, biopsy histopathology, and HMP parameters by ROC curve.
Conclusions:
Combination of donor clinical information, kidney pre-implant histopathology and
HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any measures alone.
Limitation: single-center study, retrospective, small sample.
Impact factor :
Frequency of citation of the average article in a particular year
Measure the rank of a journal by calculating the time of the source.
How is calculated: it involves the number of times an article was cited divided by the number of articles published in the same journal in the 2year previous to the year of calculation
That is a good summary. I like that you mention ‘limitations of this article’
Please provide a summary of this article
Introduction:
In the increasing need for organ transplant DCD were used in order to increased organ pool, these DCD donors kidneys have the risk of 50% delayed graft function.
This study evaluate the kidney donors clinical indicators,
as well as the histopathlogic evaluation by the donors kidney, that contribute
to delayed graft function, and the role of hypothermic machine perfusion in
halting the DGF by removing renal microthrombi, dredging renal microvessels,
and assessing renal function.
DGF is well known to increase risk of acute
rejection,increase hospital stay and costs, increase risk of CKD and reduce
graft survival.
Study design :
Retrospective cohort study in a single center in china of 188 kidneys from DCD to 333 single kidney transplants from January 2018- September 2019.
Exclusion criteria:
Recipient < 16 year old.
Re transplantation patients.
Dual kidney and multiple organ transplant recipients.
Study data:
Donor data were collected, age , sex, cause of death, serum creatinine prior recovery, history of HTN, CPR and duration of hypotension, organ cold ischemia time, warm ischemia time, and ECD.
Recipient data collected, age , sex ,number of previous kidney transplants, current level of PRA, number of HLA mismatches, DGF, and recipient follow up time.
All donor’s kidney perfused with HMP, terminal pressure (P), flow (F), and resistive index recorded at the end of perfusion.
Pre-implantation biopsy evaluation:
Two biopsies were taken one to imunnofluerescence staining, other to light microscopic exam, Remuzzi’s score were used to evaluate for chronic pathological changes in donor kidneys, and acute tubular injury. The results were obtained after transplantation avoiding selection bias
Immunosupression:
All were treated with triple therapy regimen, prednisolone, CNI, and mycophenolate Na.
All received induction by rATG, for 4-6 doses.
Definitions:
DGF = Dialysis required in the first week, after an acute kidney injury.
ECDs = donor > 60, or 50-59 years with two of the followings: HTN, cerebro-vascular death, and terminal creatinine.
Risk factors for DGF are: HTN, and creatinine before procurement.
Results:
Donor score with HMP/ HMP resistive index, and Remuzzi score correlated significantly.
ATI score significantly predictive for DGF.
Donor clinical status, biopsy, and HMP parameters estimates the risk to DGF.
Limitations:
Single center, one ethnic group (chineese), retrospective cohort.
Conclusion:
Donor risk assessment score, remuzzi’s score, and HMP (RI>3) were risk factors of DGF occurrence, and evaluate the quality of donor kidney., thus reduce the organ discard.
What is meant by the journal impact factor?
IF is the frequency with which the average article in a journal has been cited in a particular year. Two –year cited articles (A= articles published in 2019 and 2020 were cited) divided by articles citable (B= total number of “citable items” published in 2019 and 2020). IF 2021 = A/B (2019-2020).
IF indicates the power of the journal.
That is a good summary. I like that you mention ‘limitations of this article’
Comprehensive assessment of deceased
donor kidneys with clinical characteristics, pre- implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function:
Increase involvement of deceased donor lead to increase transplant chance but in extended donor criteria with less quality and increase risk of delay graft function and increase graft failure; So this article is retrospective study done in Kidney Transplant, the First Affiliated Hospital of Xi’an Jiaotong University) from January 2018 to September 2019; focus on renal biopsy of graft used to assess quality of kidney donor and ischemic injury pre implantation.
Hypothermic mechanical perfusion help to remove residual micro emboli and reduce incidence of DGF.
DGF is increase risk of acute and chronic rejection and increase length stays in hospitals and costs.
Pre-implantation biopsies were performed by the transplant surgeon using a 16G Bard needle. Two biopsies were obtained for each donation kidney. immunoflorescence staining and light microscopy depend upon Remuzzi score.
All patients receive maintenance triple immunosuppressive agents of low dose steroid and calcinurine inhibitors like cyclosporine and tacrolimus and MFF. Induction therapy by ATG.
DGF was defined as dialysis required in the first 7 days after transplantation.
ECDs defined as donors aged 60years and older, or those aged 50–59years with at least two of the following conditions: cerebro- vascular cause of death, terminal creatinine >1.5 mg/dL and/or hypertension. The incidence of DGF is increasing because of use marginal kidneys. DGF refers to the acute kidney injury which caused by CPR or hypotension during the donation and manifested by raising creatinine level. This study indicates presence of acute and chronic lesions of donation kidney play an important role in the occurrence of DGF. In this study
Remuzzi score and HMP parameters are correlated with each other. However donor score, hypertension history, sCr before donation are risk factors of DGF occurrence. Also donor score, Remuzzi score and ATI are independent risk factors for DGF occurrence post transplantation, especially ATI.
Renal biopsy histopathology and HMP parameters were all indicated for risk assessment of donated kidney. Kidneys from donors that are elderly, hypertensive or those with renal dysfunction could have chronic lesions such as glomerulosclerosis, tubular atrophy, interstitial fibrosis and arterial sclerosis. In the present study, all chronic lesions were reflected by the clinical characteristics of donors, so that donors’ clinical scores correlated with kidney biopsy histopathology scores. These lesions would also disturb the microcirculation and influence HMP parameters. This study shows that,
donor score, donation kidney Remuzzi score and HMP parameters combined together can not only evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF. This comprehensive evaluation help more safe kidney donor.
I like the scientific contents of your reply. Please type headings and subheadings. And these should be in bold or underline so that it is easier to read.
Please provide a summary of this article
In era of organ shortage,and the increase in utilizing marginal organs, the quality of donors’ kidneys and their suitability for transplantation need to be more accurately assessed to increase the likelihood of successful engraftment.
ECDs organs are at high risk for DGF development, which may increase the incidence of acute rejection and affect long-term graft survival. Therefore, it is important to investigate the risk factors of DGF and establish a predictive tool for the occurrence of DGF.
The quality assessment of organs includes clinical indicators, visual observation after donor kidney acquisition, mechanical perfusion parameters and preimplant histological evaluation (Remuzzi score).
Aim of the study:
To find a correlation between donor patient parameters, Remuzzi scores and HMP parameters collectively instead of individually with DGF development.
Materials and methods
Study cohort: Single-center retrospectively study of 181 donors and 333 recipients
Study period: from January 2018 to September 2019.
Exclusion: recipients less than 16 years old, re-transplantation patients, DKT and multi-organ transplant recipients.
Data collected on:
– Donors’ and Recipients’ characteristics were collected.
– The donor scoring system: donor’s age, primary disease, sCr levels before recovery, history of HTN, CPR and hypotension duration.
– Machine perfusion; used in all DCD for preservation. Terminal pressure (P), flow (F) and resistance index (RI) were recorded at the end of perfusion, just before the transplantation.
– Pre-implantation biopsy evaluation: 2 biopsies from each kidney evaluated by IF, H&E, PAS and Masson’s trichrome. All biopsies were performed preimplantation, but the diagnosis was determined after transplantation to avoid potential selection bias based on histopathological findings.
– Immunosuppression: All recipients were given a triple IS regimen with CNIs EC-MPS and prednisone. RATG as an induction agent.
Results:
DGF occurred in 46 (13.8%) cases.
A strong correlation exists between the donor score, HMP parameters (flow, RI) and the Remuzzi score of donor’s kidneys. However, no correlation was found between ATI and HMP parameters
Multivariate regression analysis revealed that the independent risk factors of DGF included donor score (OR . 1.12), Remuzzi score (OR 1.21)and) ATI score (OR 4.72).
On the other hand, the history of HTN, sCr, AN and HMP parameters were not independent risk factors of DGF
Prediction of DGF with ROC curve showed that the area under the curve was increased to 0.89 when all variables (donor score, Remuzzi score, ATI score and HMP resistance index) were considered together. The sensitivity and specificity of predicting
DGF were 0.804 and 0.805, respectively
Conclusions:
The data illustrate the importance of a more comprehensive evaluation of an organ. A combination of donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.
Limitations:
Retrospective study
Single center study
No ethnic variability
Level of evidence :
Retrospective cohort level 3.
What is meant by the journal impact factor?
It measures the importance or rank of a journal and the frequency of using the average article in a journal that has been cited in a particular year
The calculation is based on a two-year period and involves dividing the number of times articles were cited by the number of citable articles.
Calculation of 2022 IF of a journal:
A = the number of times articles published in 2020 and 2021 were cited by indexed journals during 2022.
B = the total number of “citable items” published in 2020 and 2021.
A/B = 2022 impact factor
That is a good summary. I like that you mention ‘limitations of this article’
III. Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre- implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function
====================================================================
Methods:
====================================================================
Results
Cohort description
====================================================================
Distribution of donor clinical score, biopsy pathology score and HMP parameters
====================================================================
Conclusions:
====================================================================
What is an impact factor?
The impact factor (IF) of a journal is a description of the influence the journal has in academic or university research circles. It is is a measure of how often the average research article in a journal has been cited or used in other research in any particular year. The IF is used to measure the importance or rank of a journal by calculating the times it’s articles are cited.
That is a good summary. I wish you could have mentioned ‘limitations of this article’
Summary
Introduction
Due to the increased expansion of the donor pool apart from living-related donations recently in China and since 2015 they allowed accepting more ECD and this can be associated with an increased risk of DGF, assessment of the donor kidney quality is very complex, and need thorough examination including donor-related clinical parameters, and allograft gross examination upon the retrieval in addition to the HMP index, donor scoring index includes age, primary disease, cause of death and post-cardiac arrest ( CPR ), history of hypertension, CVA as the cause of death hypotension, serum creatinine level at the time of donation which all can increase the risk of DGF. Histological evaluation of the kidney is also considered at the time of donation from ECD and there is diverse evidence and variation in the indication and analysis that limit its interpretation. machine perfusion (hypothermic vs normothermic MP is now widely used to preserve the organs and reduce CIT and improve the quality of the transplanted organs and further reduced the risk of DGF which can impact graft survival due to increased risk of graft rejection, fibrosis
Aim of this study
To assess the collective predictive risk of DGF from ECD in order to establish a complete donor quality assessment at the time of donation
Method
This is a retrospective cohort study from a single center reviewing the data of 333 kidney transplant recipients from DD after cardiac death (181) from 2018-2019, the mean age of recipient was around 36 while donors are older > than 50 years, they excluded recipients < 16 years old, previous transplantation, DKT and those with multiple transplantations all data belong to OPO
Both donor’s and recipient’s demographics and clinical characteristics were collected from their medical records including, age, sex,BMI, primary disease, hypertension, cause of death for the donors, warm ischemia time, cold ischemia time for ECD, hypotension episodes, creatinine level at the baseline, CPR,UOP , ECD, additional information for the recipients includes PRA, and HLA mismatches, DGF and Follow up times.
Donor scoring index
Age, Primary disease, and Serum creatinine at the time of donation
History of hypertension
CPR and Hypotension duration
Hypothermic machine perfusion was used for DCD with initial perfusion pressure setup between 30-40 then stabilize to 140 after 30 minutes
Immunosuppression
Induction with ATG, 1,25 -1.5mg/kg intraoperative and for 4-6 days followed by triple maintenance IS including CNI (both cyclosporine tacrolimus, MMF enteric coated, and prednisolone
Pathology scoring
Two core biopsies were taken from each kidney by the transplant surgeon and submitted to IF with IC staining including IgA, IgM, IgG, c1 q, Fibrin deposits, and another sample for LM and assess the renal tissue quality according to Remuzzi’s method [16] was used to evaluate chronic histopathological changes including GS, ATI , IFTA and arterial stenosis with 0-3 grading ,all biopsies done pre transplantation and the report resulted after transplantation
DGF is defined as the requirement of dialysis in the first week but they exclude cases of dialysis due to rejection or surgical complications
ECD is defined as any donor age > 60 or 50-59 with one or two of the following, CVA as the cause of death, history of hypertension, and serum creatinine > 1.5 mg/dl
Results
All recipients received DCD of donor and more from standard criteria donor in 99 (56% ) and only 45% have ECD ( 82 )
Donor age majority with a mean age of 50 years and those above 60 years d found in 24% of cases, hypertension found in > 60% of the cases with cerebral hemorrhage in 45% as cause of death followed by trauma, CPR did in 12.7%, CIT < 10 hours with mean WIT of 5 hours
All recipient received their first graft with a mean age of 36, no previous sensitization
DGF occurred in 13.8% of only
Donor score is significantly correlated with HMP flow or HMP RI (p < 0.001) and remuzzis pathology score but no significant correlation was found between ATI and HMP RI .
In multivariate logistic regression analyses, donor score, Remuzzi score and ATI still were independent risk factors for DGF incidence. In this study, the AUC predicted that DGF was increased to
0.89 when correcting the key variables (Donor score, Remuzzi score, ATI and RI) together
Conclusion
Using the combination of donor clinical criteria, with histological scoring and HMP RI collectively would help in better assessment of the graft quality and also predictive for the DGF incidence however this study is limited by being a retrospective design from a single center and reflection from the local population( China ) so we can’t generalized such finding, also the did not include DM as donor risk stratifications
What is meant by the journal impact factor?
The Journal impact factor as an index factor calculated the mean number of citations of articles published in the last two years in a given journal, so the impact factor of the renal failure journal for 2021- 2022 is 2.606.
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
however this study is limited by being a retrospective design from a single center and reflection from the local population( China ) so we can’t generalize such findings,
they did biopsies for all ECD and SCD and they have younger recipients
also, they did not include DM as donor risk stratification
Dear prof, I mentioned the limitation in the last paragraph and I again repeated in a separate paragraph below
Thanks
Oh yes, Dr Saja. I note your point. It is clearer to me now.
To mitigate high demand for transplant tissue, an increasing proportion of kidney donors are considered extended criteria donors, which results in a higher incidence of delayed graft function (DGF) in organ recipients. To ensure a more safe and effective use of the donor kidney, this study establish a prediction system to assess donor kidney quality before transplantation
Combining donor score, Remuzzi score, ATI and HMP RI together provides the most accurate prediction of DGF. And this study showed that the AUC predicted DGF was increased to 0.89 when fitting the key variables together. The sensitivity and specificity of predicting DGF were 0.804 and 0.805, respectively.
Journal impact factor reflects the yearly mean number of citations of articles published in the last two years in a given journal.
I note your summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
Journal impact factor IF is the indicator of the importance of the journal in certain field. It measures frequency of citation of average article in the specific journal in the specific period of time, can be calculated after 3 years of publication, so cannot be used for the new journals before 3 years. the highest IF the most important journal.
Mohit Sharma, Anurag Sarin, Priyanka Gupta, Shobhit Sachdeva,Ankur V. Desai. Journal Impact Factor: Its Use, Significance and Limitations. World J Nucl Med. 2014 May-Aug; 13(2): 146.DGF delayed graft function can be defined as the need of dialysis in the first week post-transplant not due to acute rejection nor surgical complications, DGF is common with deceased kidney donation especially when use ECD kidney as old age donor, donor with the history of hypertension or diabetes or even impaired kidney function in the form of AKI.So the predilection of DGF is not depends on one factor only , it depends on multiple factors like clinical condition of the donor (age and morbidities), histopathological analysis of pre-transplant kidney donor biopsy and its score (Remuzzi score), also on the hypothermic machine perfusion HMP.Donor score system includes the following:Age, morbidities, serum creatinine before retrieval, duration of hypotension and incidence of cardiopulmonary resuscitation CPR.
. I note that your definition of IF is incomplete and incorrect
Introduction
Because there is such a high demand for transplant tissue at the moment, an increasing percentage of kidney donors are meeting what are known as extended criteria, which leads to a higher incidence of delayed graft function in organ recipients. As a result, it is critical to conduct exhaustive research on the factors that increase the likelihood of developing DGF and to develop a prediction system that can evaluate the quality of donor kidneys prior to transplantation.
Because the ECD accounts for the vast majority of kidney donations, there is a pressing need for improved methods of evaluating the kidneys of potential donors and determining whether or not they are suitable for transplantation. This will allow for a higher chance of a successful engraftment.
Materials and methods
A retrospective study evaluated the records of 181 donors and 333 recipients of a single kidney transplant at Department of Kidney Transplant, the First Affiliated Hospital of Xi’an Jiaotong University, from January 2018 to September 2019. Recipients that were less than 16 years old, re-transplantation patients, dual kidney and multi-organ transplants recipients were excluded.
– Age, sex, cause of death, sCr levels prior to organ recovery, history of hypertension, incidence of CPR and hypotension duration, organs cold ischemia time and warm ischemia time, and ECD were obtained for each donor.
– Recipient characteristics at the time of transplant, including age, gender, number of previous kidney transplants, current level of panel-reactive antibodies, number of human leukocyte antigen mismatches, graft-versus-host disease, and period of recipient follow-up.
– All donation after cardiac death (DCD) kidneys included in our study were perfused in situ and preserved by an HMP device.
– Pre-implantation biopsy evaluation Pre-implantation biopsies were performed by the transplant surgeon using a 16G Bard needle. Two biopsies were obtained for each donation kidney.
Results
The mean donor age was 50.8 ± 12.5 years (range 16–73 years)
48 donors (26.5%) were 60 years of age
The main primary diseases of donors were cerebral hemorrhage (45.3%) and trauma (43.1%)
The mean terminal sCr concentration of donors before procurement was 113.0 ± 78.7 mmol/L
The mean warm and cold ischemia time were 5.1 ± 2.2 min and 8.7 ± 3.4 h, respectively.
– Correlations exist between the donor clinical scores, the kidney histopathologic Remuzzi scores, and the hypothermic mechanical perfusion parameters (flow and resistance index).
– The incidence of DGF postoperatively was 13.8%, with 46 patients developing the condition.
– Donor score, Remuzzi score, and acute tubular injury score were identified as independent risk factors for the development of DGF by multivariate logistic regression analysis.
– When all variables (donor score, Remuzzi score, ATI score, and HMP resistance index) were assessed in conjunction with one another, the area under the receiver operating characteristic curve for predicting DGF improved to 0.89.
Conclusion
Clinical information, the histology of the biopsies, and the HMP characteristics were all indicated for the risk evaluation of donated kidneys, which suggests that there is some kind of relationship between them. The Donor score, the Remuzzi score, and the ATI were recognized as independent DGF risk factors. It is possible to improve the DGF prediction following transplantation by combining donor clinical information, kidney pre-implant histology, and HMP features.
Impact Factor reflect the number of citations of articles published in the last two years in a given journal
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
This is a single-center, retrospective cohort study with 181 donors and 333 recipients between January 2018 and September 2019 in which children under 16 years of age, previous transplants, double kidney transplants, and multi-organ transplants were excluded. The pre-transplantation biopsies of these organs were submitted to the Ramuzzi pathological score and to the parameters of perfusion machines.
These 181 donors were divided into 99 standard donation criteria and 82 expanded criteria donations. The latter is always more related to late graft response and worse short- and long-term outcomes. Patients were evaluated by clinical scores (KDPI), pre-transplantation biopsies for organic viability assessment, and perfusion machine, which in turn reduces microthrombi, drains renal vessels, and decreases the inflammatory process of the reperfusion syndrome. All patients with cardiovascular disease used a perfusion machine, as well as a pre-transplant biopsy for Ramuzzi’s criteria. Immunosuppression is always with rATG induction and a triple maintenance regimen (CNI, sodium mycophenolate, and prednisone).
Of the 181 donors, 115 were hypertensive and 23 had undergone cardiopulmonary resuscitation. As for the 333 recipients, 46 had DGF.
KDPI showed five or fewer points in 105 recipients, 6-15 points in 179, and 16-30 points in 49 patients, with an OR of 1.17 for DGF. SAH showed OR 1.18 and serum creatinine OR 1.01.
In Remuzzi’s criteria, 244 patients scored 0-3, 84 patients scored 4-6, and 5 above or equal to 7, with OR 1.33.
On clinical criteria using ATI score, 292 were low risk, 35 medium, and 6 high risk, with OR 5.38. KDPI, Remuzzi, and ATI are risk factors independent of FGD.
The perfusion machine criteria considered two points (OR: 2.97):
1. Flow (mL/min) with better prognosis in patients above 80mL/min
2. Vascular resistance (mmHg/mL/min) with better response in patients <0.4 mmHg/mL/min
To acquire more accurate data, the combination of at least 3 criteria (Remuzzi, ATI, KDPI, HMP) brings more robust data for DGF prediction.
Impact Factor – Number of citations of articles published in the last two years in a given journal
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
Summary:
Aim:
Methods:
Results:
Conclusions: Combination of donor clinical information, kidney pre-implant histopathology and HMP parameters provide a more accurate prediction of DGF occurrence post-transplantation than any of the measures alone.
Journal impact factor:
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
Comprehensive assessment of deceased donor kidneys with clinical characteristics, pre-implant biopsy histopathology and hypothermic mechanical perfusion parameters is highly predictive of delayed graft function.
Donation from DCD is considered one of the major source worldwide currently but still one of the major downside is DGF which affect graft survival and so need accurate method to detect kidney quality before transplantation.
Assessment depends on many factors such as :
Donor scoring system: includes donor’s age, primary diseases, history of hypertension, pre-donation creatinine level, occurrence of cardiopulmonary resuscitation (CPR) and hypotension, all of which are closely related to DGF after kidney transplantation.
Histopathological evaluation: to assess ischemic injury in the donated kidney as well as chronic changes, using Remuzzi scores.
Hypothermic mechanical perfusion (HMP):which used for removing residual renal micro thrombi, dredging renal micro vessels and provide measures.
Aim of the study:
the correlation of donor patient parameters, kidney pre-implant pathology Remuzzi scores and HMP parameters were analyzed collectively, to evaluate of donor kidney quality and to select the best donor organ for a given patient, even in the face of an organ shortage.
Materials and methods.
A retrospectively studied the records of 181 donors and 333 recipients of a single kidney transplant from January 2018 to September 2019, recipients that were less than 16 years old, re-transplantation patients, dual kidney and multi-organ transplants recipients were excluded with mean follow-up time after transplantation was 297.8 ± 110.1 days.
Data collected about donors and recipients and using donor scoring system parameters of HMP and Terminal pressure (P), flow (F) and resistance index (RI) were recorded at the end of perfusion, just before the transplantation also Pre-implantation biopsy evaluation and immunosuppression drugs.
DGF was defined as dialysis required in the first 7 days after transplantation but not due to acute rejection.
ECD defined as donors aged 60 years and older, or those aged 50–59 years with at least two of the following conditions: cerebrovascular cause of death, terminal creatinine >1.5 mg/dL and/or hypertension.
Results.
Distribution of donor clinical score: 105 cases were less than or equal to 5, 179 cases were in the range of 6 and 15 and 49 cases were in the range of 16 and 30.
Biopsy pathology score: 244 grafts were scored 0–3, 84 grafts were scored 4–6 and only 5 grafts were in the range of 7 and 12.
HMP parameters: Flow parameters of most grafts (309 cases) were more than 80 mL/min, and the lowest flow parameter was 48 mL/min. The resistance index of most cases (310/333) was less than 0.4 mmHg/(mL/min), and the highest resistance index was 0.70 mmHg/(mL/min).
A strong correlation also exists between either the donor score or HMP parameters and the Remuzzi score of donor kidneys.
High donor score and Remuzzi score had a higher risk of developing DGF.
Donor score, Remuzzi score and ATI still were independent risk factors for DGF occurrence.
When all variables (donor score, Remuzzi score, ATI score and HMP resistance index) were considered together, The Prediction of DGF with ROC curve showed that the area under the curve was increased to 0.89.
Conclusion:
Comprehensive assessment of deceased donor kidney by clinical characteristics, biopsy histopathology features and HMP parameters together is so important not only to evaluate the quality of donor kidney, but also more accurately predict the occurrence of DGF, In particular, donor score, hypertension history, sCr before procurement, Remuzzi score, AN, ATI and HMP RI 3 were risk factors of DGF occurrence.
What is meant by the journal impact factor?
The impact factor (IF) is a measure of the frequency with which the average article in a journal has been cited in a particular year. It is used to measure the importance or rank of a journal by calculating the times its articles are cited.
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
Please provide a summary of this article
Introduction
To increase kidney donor pool, more ECD are used. Most deceased kidney donors are considered ECD with the risk of graft failure, DGF and PNF
Assessment of the donor kidney includes donor status before donation (age, primary diseases, HTN, creatinine level, occurrence of CPR and hypotension), histopathology and HMP
DGF may increase the incidence of acute rejection after organ transplantation and increase hospitalization time and cost
Aim of the study: a retrospective cohort study to assess and predict the risk factors of DGF
Materials and methods
A retrospective study of 181 donors (99 cases of SCD (54.7%) and 82 cases of ECD (45.3%)) and 333 recipients of a SKT at one center (January 2018 to September 2019)
Exclusion criteria were recipients less than 16years old, re-transplantation patients, dual kidney and multi-organ transplants recipients
The donor scoring system was donor’s age, primary disease, sCr levels prior to organ recovery, history of HTN, CPR incidence and hypotension duration
All donations after DCD kidneys were perfused in situ and preserved by an HMP device
Two biopsies for each donation kidney and Remuzzi’s score used for evaluation
Immunosuppressive regimen was CNIs, enteric- coated mycophenolate sodium and prednisone and induction therapy was rabbit antidemocratic globulin
DGF: dialysis required in the first 7days after transplantation (exclude acute rejection and surgical complications)
Results
The mean donor age was 50.8±12.5 years (range 16–73years); 48 donors (26.5%) were 60years or more of age
The mean recipient age was 36.2±9.3 years (range 12–65). All recipients received their first allograft and most were not sensitized
Of the 333 recipients, DGF occurred in 46 recipients (13.8%)
Risk factors of DGF occurrence were higher donor score, history of HTN, S.cr before procurement, Remuzzi score, AN, ATI and HMP RI of 3 or more
In multivariate logistic regression analyses, donor score, Remuzzi score and ATI were independent risk factors for DGF
Discussion
In this study, all chronic lesions were reflected by the clinical characteristics of donors, so that donors’ clinical scores correlated with kidney biopsy histopathology scores (these lesions also may disturb the microcirculation and influence HMP parameters)
No correlation between ATI and HMP parameters (little effect of renal tubule on microcirculation). Also there was no statistical correlation between GS and HMP parameters
Conclusions
Risk factors of DGF occurrence were donor score, history of HTN, S.cr before procurement, Remuzzi score, AN, ATI and HMP RI of 3 or more (especially RI)
Donor score, Remuzzi score and ATI were independent risk factors for DGF (especially ATI)
Donor score, Remuzzi score and HMP parameters combined together can evaluate the quality of donor kidney and predict the occurrence of DGF
What is meant by the journal impact factor?
Is a scientometric index calculated by Clarivate that reflects the yearly mean number of citations of articles published in the last two years in a given journal
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
Introduction
Organs from deceased donors became the only method for donation in China since 2015 and most these donors are considered ECD having higher incidence of DGF and graft failure .
Therefore it is necessary to access the donated kidney quality and possible prognosis .
The donor scoring system includes donor’s age, primary diseases, history of hypertension, creatinine level, cardiopulmonary resuscitation (CPR) and hypotension, all of which are closely related to DGF after kidney transplantation.
Biopsy done before implantation to evaluate the chronic renal affection and the ischemic injuries.
Hypothermic mechanical perfusion (HMP) reduces DGF risk by removing residual renal microthrombi.
Donor patient parameters, kidney before transplantation pathology Remuzzi scores and HMP parameters were analysed altogether.
Methods
A retrospective cohort study on 181 donors and 333 recipients of a single kidney transplant within 1 year and 8 months.
The organs retrieved from DCD donors were perfused in situ and preserved by HMP device.
2 biopsies were taken before implantation, Remuzzi method was used to assess the chronic histological changes.
Recipients received induction therapy with rabbit anti-thymocyte
globulin and maintenance with CNI , enteric coated mycophenolate sodium, prednisolone.
Results
The study included 99 cases standard criteria donors and 82 cases of
ECD.
The primary disease of the donors were cerebral haemorrhage and trauma.
The mean seum Creatinine concentration of donors before donation was 113.0 ± 78.7 mmol/L. The mean warm ischemia time was 5.1 ± 2.2 min and cold ischemia time was 8.7 ± 3.4 h.
DGF occurred in 46 cases with minimum follow up of 3 months.
Clinical scores were ;105 cases were less than or equal to
5; 179 cases were in the range of 6 and 15; 49 cases were in the range of 16 and 30; the highest score was 27.
Remuzzi score was 244 grafts were scored 0–3, 84 grafts were scored 4–6 and only 5 grafts were in the range of 7 and 12 (the highest score was 8).
Flow parameters of most grafts were more than 80 mL/min,
and the lowest flow parameter was 48 mL/min.
Donor score correlated significantly with HMP flow or HMP RI.
Patients who received a kidney from donor with high score had a higher risk of DGF.
Remuzzi score, Arteriole narrow score, ATI score, HMP flow index and RI correlated with development of DGF.
Donor score, Remuzzi score and ATI were independent risk factors for DGF.
The ROC analysis revealed that the calculated AUC of the 5 evaluated variables were less than 80% .
Discussion
DGF incidence increased due to the use of marginal kidneys.
Donor score, Remuzzi score and ATI were independence risk factor of DGF indicating that acute and chronic lesions of donated kidney affects the occurrence of DGF.
The donor evaluation system involved KDPI score , donor’sage, cerebrovascular cause of death, hypertension history , sCr before donation, hypotension and CPR incidence.
Kidney biopsy before donation evaluate the kidney quality by assessing the chronic histopathological lesions by Remuzzi score.
HMP allows accessing kidney viability by tracing measures of perfusate flow rate and vascular resistance.
Donor score , Remuzzi score, ATI and HMP RI >3 all together were considered the most accurate predictor of DGF.
Previously the pathological analysis was the only tool to decide for the graft quality but currently comprehensive assessment is applied to avoid kidney wasting.
ATI and HMP parameters did not correlate ,it was justified that acute kidney injury affected the renal tubule, which had little effect on microcirculation.
Also GS and HMP did not show any correlation could be due to low GS ratio that won’t affect HMP parameters.
Conclusion
Clinical characteristics, biopsy histopathology features and HMP parameters combined together can provide a tool for donor evaluation and predict DGF occurrence.
– Journal impact factor is a measure of the frequency by which the average article in a journal has been cited in a certain year.
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete
Club 3; predictors of DGF AS (donor criteria, pre-implant biopsy and hypothermic machine perfusion)
Summary
· Increase need to use of EDC in DDKT leads to higher incidence of DGF, hence need for prediction of DGF is essential to properly choose the best recipient for each donor, as old for old concept to allow use of marginal donor.
· DGF increase incidence of acute rejection, increase hospital stay and cost and eventually affect graft survival and outcomes.
· The current study was retrospective cohort to evaluate risk factors for DGF.
· Combined assessment of donor criteria, pre-implant biopsy and hypothermic machine perfusion can help in predicting DGF.
· Clinical criteria of the donor before organ recruitment by scoring system including: donor age, cause of death (trauma, hemorrhage, ischemia, brain tumors), hypertension, diabetes, predonation creatinine, need for CPR and occurrence of hypotension, cold and warm ischemia time. Kidney donor profile index (KDPI) is essential for evaluation of the quality of organ.
· Clinical criteria of the recipient as age , sex, immunological risk including PRA and HLA mismatch, previous transplantation.
· Machine kidney perfusion that remove the residual microthrombi and improves renal microcirculation. In addition, it allows assessment of graft viability through measuring of pulsatile flow rate and vascular resistive index.
· Kidney biopsy is done in ECD to assess chronic changes (glomerulosclerosis, tubular atrophy, interstitial fibrosis and arteriolar changes) and ischemia induced injury, findings as scored in Remuzzi score can predict DGF. Kidney Tissue was examined by IF and LM.
· The current study found that remuzzi score, ATN in graft and machine perfusion resistive index (RI>3) are the most important predictors of DGF and evaluate the quality of donor kidney.
· Chronic histopathological changes is correlated well with clinical criteria of the donor.
· Currently, not only pathology is the determining factor to use or discard the kidney, but combined assessment of all above-mentioned parameters.
· No correlation between machine perfusion and AKI
· Type of the study: retrospective cohort (III)
· Limitations; retrospective, single center and small sample (181 donors and 333 recipients).
· Impact factor is an index determined by Clarivate’s web of science indicating how much citations are done for certain journal in the previous 2 years. The higher the impact factor, the more important and specialized journal in its field.
That is a well-typed summary and you mention ‘limitations of article’.
Aim of the study:
Evaluation the correlation between donor information, Remuzzi score & HMP parameters.
Materials & method:
Result & discussion:
Impact factors: is a tool used to evaluate the importance of journals through measuring the frequency of citation in particular time ( e.g. number of citation published in last 2 years within a particular journal).
That is a well-typed summary but it does not mention ‘limitations of article’. I note that your definition of IF is incomplete