Risk factors and consequences of delayed graft function

Abstract

The impact of delayed graft function (DGF) on the outcome of renal transplantation remains controversial. We analyzed the risk factors for DGF and its impact on graft and patient survival. A total of 354 renal transplants performed between June 1986 and April 2000 were analyzed. Variables analyzed included donor and recipient age, method and duration of renal replacement therapy, HLA mismatch, cold and warm ischemia times, biopsy-confirmed acute rejection, length of stay in the hospital, serum creatinine at the end of first hospitalization as well as graft and patient survival at one, three, five and ten years. The study patients were divided into two groups: patients with DGF (G1) and those without DGF (G2). DGF occurred in 50 patients (14.1%), and it was seen more frequently in patients transplanted from deceased donors (60% vs. 40%, P <0.0001). The cause of DGF was acute tubular necrosis, seen in 98% of the cases. Univariate analysis showed a statistically significant difference between the two groups G1 and G2 in the following parameters: average duration on dialysis (52.3 vs. 36.4 months, P = 0.006), HLA mismatch (44.9% vs. 32.11% P = 0.015), donor age (35.9 vs. 40.2 years, P = 0.026), cold ischemia time (23 vs. 18.2 h, P = 0.0016), warm ischemia time (41.9 vs. 38.6 mn, P = 0.046), length of stay in the hospital during first hospitalization (54.7 vs. 33.2 days, P <0.0001), serum creatinine at the end of first hospitalization (140 vs. 112 μmol/L, P <0.0001) and at three months following transplantation (159 vs. 119 μmol/L, P = 0.0002). Multivariate analysis revealed the following independent risk factors for DGF: deceased donor (RR = 13.2, P <0.0001) and cold ischemia time (RR = 1.17, P = 0.008). The graft survival at one, three, five and ten years was 100%, 93%, 88.3% and 78.3% in G1 versus 100%, 95.9% 92.8% and 82.3% in G2; there was no statistically significant difference. The patient survival at one, three, five and ten years was 100%, 91.3%, 83.6% and 74.4% in G1 versus 100%, 95.9%, 94% and 82.6% in G2 with a statistically significant difference (P = 0.04). Prolonged cold ischemia time and transplantation of kidneys from deceased donors were the main risk factors for DGF in our study. Also, DGF significantly affected patient survival but had no influence on graft survival.

Urinary Kidney injury molecule‐1 can predict delayed graft function in living donor renal allograft recipients

“…The incidence of DGF is common in deceased donor transplants compared to living donor renal transplant recipients . With increasing laparoscopic donor nephrectomy and warm ischaemia time, the incidence of ATN has increased .…”

“…4,5 The incidence of DGF is common in deceased donor transplants compared to living donor renal transplant recipients. 6 With increasing laparoscopic donor nephrectomy and warm ischaemia time, the incidence of ATN has increased. 7,8 Serum creatinine, a gold standard biochemical parameter for the laboratory diagnosis of kidney injury, increases late and after significant decline in glomerular filtration rate.…”

Kidney Transplantation: Local Donor and Distant Recipient, Is It Feasible? A Retrospective Cross-Sectional Study

“…Previous studies reported fairly high CIT in some current allocation systems; for example, CIT reported from United States, Turkey, and Tunisia, 21 ± 7, 14, and 18 to 23 hours, respectively (23)(24)(25).…”

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“…This finding was matched with some reports denoting that slow and delayed graft function are risk factors for T-cell and antibodymediated rejection 19 and the combination of both can affect patient survival. 20,21 Most of our patients were young females, and this was explained by Dörje and associates 2 who found that most of their patients with rejection were young and nonadherent with suboptimal immuno suppression.…”