Association Between Perioperative Daprodustat Use and Early Posttransplant Graft Function in Living Donor Kidney Transplantation: A Propensity Score-Matched Retrospective Study.
Daprodustat may improve early graft function in living donor kidney transplantation, but further studies are needed to confirm these findings.
Where it sits
this study against the rest of the erythropoietin (epo) corpusSummary and findings
This study evaluated the effects of daprodustat on early posttransplant graft functions in living donor kidney transplantation. A total of 64 patients were included, with 32 receiving daprodustat from preoperative Day 1 to postoperative Day 7. The daprodustat group exhibited better graft function compared to the control group.
Abstract
Background Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors, such as daprodustat, have demonstrated nephroprotective effects in preclinical models. However, their potential benefits in living donor kidney transplantation (LDKT) remain unclear. This study aimed to evaluate the effects of daprodustat on early posttransplant graft functions in LDKT. Methods This single-center study evaluated LDKT recipients transplanted between August 2019 and November 2023. Patients were divided into the daprodustat group, who received the drug from preoperative Day 1 to postoperative Day 7, and the control group, who did not receive HIF-PH inhibitors during this period. Propensity score matching yielded 32 patients per group. Results The daprodustat group exhibited better graft function, reflected by higher estimated glomerular filtration rates in the early posttransplant period (mean ± standard deviation: Week 1, 53.3 ± 16.1 vs control 41.9 ± 17.9 mL/min/1.73 m²; P = 0.001; Week 2, 55.3 ± 17.6 vs 46.0 ± 15.1; P = 0.008). The incidence of slow graft function was significantly lower in the daprodustat group (0.0% vs 12.5%, P = 0.039). No delayed graft function or thrombotic events occurred, and rejection did not differ between groups. Conclusions These findings raise the possibility that perioperative daprodustat use may be associated with improved early graft function in LDKT, warranting further investigation.
Background
This paper addresses the potential nephroprotective effects of HIF-PH inhibitors, specifically daprodustat, in the context of living donor kidney transplantation (LDKT). Prior research has indicated benefits of HIF-PH inhibitors in preclinical models, but their impact on early graft function in LDKT remains unclear. Understanding the effects of daprodustat could inform perioperative management strategies for kidney transplant recipients.
Methods
This was a single-center, propensity score-matched retrospective study involving LDKT recipients transplanted between August 2019 and November 2023. A total of 64 patients were evaluated, with 32 in the daprodustat group receiving the drug from preoperative Day 1 to postoperative Day 7, and 32 in the control group not receiving HIF-PH inhibitors. The primary outcome measure was early posttransplant graft function, assessed by estimated glomerular filtration rates.
Results
The daprodustat group exhibited a higher estimated glomerular filtration rate at Week 1, with a mean of 53.3 ± 16.1 mL/min/1.73 m² compared to 41.9 ± 17.9 mL/min/1.73 m² in the control group (P = 0.001). At Week 2, the daprodustat group also had a higher estimated glomerular filtration rate of 55.3 ± 17.6 vs 46.0 ± 15.1 (P = 0.008). Additionally, the incidence of slow graft function was significantly lower in the daprodustat group at 0.0% compared to 12.5% in the control group (P = 0.039). No delayed graft function or thrombotic events were reported.
Interpretation
These findings suggest that daprodustat may have a beneficial effect on early graft function in LDKT, as indicated by statistically significant improvements in estimated glomerular filtration rates. However, the clinical significance of these findings is uncertain, especially given the small sample size and single-center nature of the study. Further research is needed to validate these results and explore the implications for clinical practice.
Key findings
- Week 1 estimated glomerular filtration rate: 53.3 ± 16.1 vs control 41.9 ± 17.9 mL/min/1.73 m²; P = 0.001
- Week 2 estimated glomerular filtration rate: 55.3 ± 17.6 vs 46.0 ± 15.1; P = 0.008
- Incidence of slow graft function: 0.0% vs 12.5%; P = 0.039
- No delayed graft function or thrombotic events occurred
- Rejection did not differ between groups
Limitations
- single-center study
- small sample size n=64
- retrospective design
- short follow-up period