Non-Heart Beating Donor Kidneys with Delayed Graft Function Have Superior Graft Survival Compared with Conventional Heart-Beating Donor Kidneys That Develop Delayed Graft Function

Abstract

Delayed graft function may have an association with reduced graft survival, and nonheart-beating donor (NHBD) kidneys have higher rates of delayed graft function (DGF) than heart-beating donor (HBD) kidneys. This study compared outcome of renal transplants from HBDs who developed DGF, with NHBDs who developed DGF.All recipients of HBD and NHBD kidneys who developed DGF were identified during a 10-year period. All patients with graft primary nonfunction were excluded from analysis.Four hundred and fifty-six functioning transplants were performed. Delayed graft function occurred in 69 (17%) HBD and 55 (93%) NHBD kidneys. The grafts developing DGF were well matched for donor and recipient age. The rate of acute rejection was similar; [n = 16/69 (23%) HBD vs. n = 13/55 (24%) NHBD]. Cold ischaemia was 21 h in the HBD group and 17 h in NHBD group (p > 0.05). Serum creatinine was similar for both groups at 1.3 and 6 years (p > 0.05 for all time points). Graft survival in the NHBD recipients with DGF was significantly better at 3 years (84%) compared with recipients of a HBD renal transplant that developed DGF (73%) (p < 0.05), and at 6 years (62% survival for HBDs and 84% survival for NHBDs).This study shows that graft survival was better for NHBD kidneys up to 6 years after transplantation.

Outcome of Nonheart‐Beating Donor Kidneys with Prolonged Delayed Graft Function after Transplantation

“…Compared with HBD kidneys, graft survival of NHBD kidneys with DGF is better (15). DGF in NHBD kidneys is largely affected by the unavoidable warm ischemic renal insult, which may be completely different from the cause of DGF in heart-beating kidneys.…”

“…In renal allografts from heartbeating donors (HBD), DGF is reported as an independent risk factor for reduced long-term graft (8,9) and patient survival (10). Others report no effect on long-term outcome (11,12), although there may be an adverse effect on the long-term renal function if DGF is associated with periods of acute rejection (AR) (14,15). It is also suggested that DGF longer than 3 weeks leads to a higher mortality, while the effect on late graft function is less important (10).…”

Expanding Opportunities for Kidney Transplantation

“…Additionally, HMP permits longer preservation times without significant consequences to the allograft. Current notions suggest that HMP prevents and/or ameliorates injury to the kidney suffered as a result of preagonal hemodynamic and metabolic perturbations to the donor [25,26].…”

Effect of a Single Intraoperative High-Dose ATG-Fresenius on Delayed Graft Function in Donation After Cardiac-Death Donor Renal Allograft Recipients: A Randomized Study

“…Finally, delayed graft function is a risk factor for acute rejection and graft loss, although the detrimental effect of delayed graft function on graft survival appears to be much weaker in transplants with DCD donor renal allograft than in transplants with donation after brain death donor renal allografts. 4,5 Consequently, reducing the incidence of delayed graft function after transplant with DCD donor renal allografts would facilitate managing recipients during the first weeks after a transplant and potentially improve long-term outcomes.…”