Delayed Graft Function After Renal Transplantation1

Abstract

Donor factors associated with DGF were increased ischemia, donor age, and cause of death. Although there is a close association between DGF and reduced GS, there is no association between these donor factors and GS. This seeming paradox suggests that unknown variables contribute heavily to early graft outcome.

“Nature versus Nurture” Study of Deceased-Donor Pairs in Kidney Transplantation

“…Two studies of common-donor recipient pairs detected similar rates of DGF within each of the common-donor recipient pairs, similar to our study. 23,24 Our study suggests that unmeasured donor factors such as donor genetic variants may play a significant role in transplant outcomes. There is an emerging interest in the possibility that genetic or biochemical variation among donors plays a role in kidney transplant outcomes.…”

“…Our results are consistent with previous, smaller studies. [22][23][24] In those previous studies, no discernible effect of donor factors on allograft function was present at 6 mo after transplantation. In contrast, our study suggests that donor factors remain important contributors to allograft survival up to 3 yr after transplantation.…”

“…4,6,[15][16][17][18][19][20][21] A limited effort has been made to evaluate the relative contribution of these risk factors by exploiting that there is variation in the response of recipients of kidneys from the same donor. 18,[22][23][24] This approach is similar to studies of monozygotic twins reared apart, which seek to quantify the relative importance of environmental and genetic factors on the basis of variability within twin pairs and among twin pairs. 22,25 Analyses that examine outcomes in two recipients of kidneys from the same deceased donor can be used to determine the donor's relative contribution to the recipients' outcomes.…”

Delayed graft function in renal transplantation

“…Marcussen concluded there were no differences between biopsies with ATN of native and transplanted kidneys, as far as the composition of the interstitial infi ltrates is concerned (6) but that in contrast to acute rejection episodes the infi ltrate in ATN consisted mainly of granulocytes. Haug and Dragun showed in animal models that the detrimental effects of ischemia and reperfusion could be minimized with neutropenia and the use of blocking anti-bodies against ICAM-1, LFA-1 and P-selectin (63) or ICAM-1 antisense oligodesoxynucleotides (64).…”

“…During surgery errors in line placement can result in inadequate fl ushing of blood and / or cooling, and undue manipulation of renal arteries can induce vascular spasm (53). The most important independent and robust risk factor is the time that it takes from the explantation of the kidney until its transplantation into the recipient , defi ned by the cold ischemia time (CIT) (57)(58)(59)(60)(61)(62)(63). The type of preservation fl uid also is recognized as a risk factor for DGF in a study in the Eurotransplant area, in which the preservation fl uid developed by the University of Wisconsin (UW) appeared to be superior to Euro Collins (EC) (64).…”