Risk factors and consequences of delayed graft function in renal transplantation

Authors

Keywords:

Kidney transplantation, Delayed graft function, Allograft rejection

Abstract

Background/Aim: Delayed graft function (DGF) continues to be an important complication in patients who underwent kidney transplantation. Our study aimed to determine the rate of DGF and risk factors after renal transplantation at our center and explore DGF-related complications and outcomes. Methods: Patients over 18 years of age who underwent kidney transplantation between January 2015 and January 2020 were evaluated. DGF was defined as the need for at least one dialysis session within the first week after renal transplantation. The factors affecting DGF were analyzed as the primary outcome, and discharge and additional complications, as the secondary outcomes. Results: Data of 206 patients who underwent renal transplantation were analyzed, and delayed graft function (the need for at least one dialysis session within the first week after renal transplantation) was observed at a rate of 20.9%. A statistically significant relationship was observed between DGF and presence of diabetes mellitus, cadaver graft transplantation, higher cold ischemia time, need for postoperative erythrocyte suspension and fresh frozen plasma transfusion (P<0.05 for all). Graft loss was significantly higher in patients with DGF (P=0.001). Conclusion: After renal transplantation, delayed graft function continues to occur at a high rate. Prevention of delayed graft function development will reduce graft loss rates.

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References

Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet. 2004;364(9447):1814-27. doi: 10.1016/S0140-6736(04)17406-0. PubMed PMID: 15541456.

Willicombe M, Rizzello A, Goodall D, Papalois V, McLean AG, Taube D. Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol. World journal of transplantation. 2017;7(1):34-42. Epub 2017/03/11. doi: 10.5500/wjt.v7.i1.34. PubMed PMID: 28280693; PubMed Central PMCID: PMCPMC5324026.

Bahl D, Haddad Z, Datoo A, Qazi YA. Delayed graft function in kidney transplantation. Curr Opin Organ Transplant. 2019;24(1):82-6. doi: 10.1097/MOT.0000000000000604. PubMed PMID: 30540574.

Gourishankar S, Jhangri GS, Cockfield SM, Halloran PF. Donor tissue characteristics influence cadaver kidney transplant function and graft survival but not rejection. J Am Soc Nephrol. 2003;14(2):493-9. doi: 10.1097/01.asn.0000042164.03115.b8. PubMed PMID: 12538752.

Schroppel B, Legendre C. Delayed kidney graft function: from mechanism to translation. Kidney Int. 2014;86(2):251-8. doi: 10.1038/ki.2014.18. PubMed PMID: 24522494.

Gjertson DW. Impact of delayed graft function and acute rejection on kidney graft survival. Clin Transpl. 2000:467-80. PubMed PMID: 11512359.

Morath C, Döhler B, Kälble F, da Silva LP, Echterdiek F, Schwenger V, et al. Pre-transplant HLA Antibodies and Delayed Graft Function in the Current Era of Kidney Transplantation. Frontiers in Immunology. 2020;11.

Irish WD, Ilsley JN, Schnitzler MA, Feng S, Brennan DC. A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant. 2010;10(10):2279-86. doi: 10.1111/j.1600-6143.2010.03179.x. PubMed PMID: 20883559.

Song SH, Jung D, Chung KY. Risk factors of delayed graft function in deceased donor kidney transplantation. 대한이식학회지. 2020;34(4):109-.

Irish WD, McCollum DA, Tesi RJ, Owen AB, Brennan DC, Bailly JE, et al. Nomogram for predicting the likelihood of delayed graft function in adult cadaveric renal transplant recipients. J Am Soc Nephrol. 2003;14(11):2967-74. doi: 10.1097/01.asn.0000093254.31868.85. PubMed PMID: 14569108.

Butala NM, Reese PP, Doshi MD, Parikh CR. Is delayed graft function causally associated with long-term outcomes after kidney transplantation? Instrumental variable analysis. Transplantation. 2013;95(8):1008-14. doi: 10.1097/TP.0b013e3182855544. PubMed PMID: 23591726; PubMed Central PMCID: PMCPMC3629374.

Mannon RB. Delayed Graft Function: The AKI of Kidney Transplantation. Nephron. 2018;140(2):94-8. doi: 10.1159/000491558. PubMed PMID: 30007955; PubMed Central PMCID: PMCPMC6165700.

Lauronen J, Peräsaari JP, Saarinen T, Jaatinen T, Lempinen M, Helanterä I. Shorter Cold Ischemia Time in Deceased Donor Kidney Transplantation Reduces the Incidence of Delayed Graft Function Especially Among Highly Sensitized Patients and Kidneys From Older Donors. Transplantation Proceedings. 2020;52(1):42-9. doi: 10.1016/j.transproceed.2019.11.025.

Allen R, Pleass H, Clayton PA, Woodroffe C, Ferrari P. Outcomes of kidney paired donation transplants in relation to shipping and cold ischaemia time. Transpl Int. 2016;29(4):425-31. doi: 10.1111/tri.12719. PubMed PMID: 26576040.

Debout A, Foucher Y, Trebern-Launay K, Legendre C, Kreis H, Mourad G, et al. Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney Int. 2015;87(2):343-9. doi: 10.1038/ki.2014.304. PubMed PMID: 25229341.

Zachary AA, Leffell MS. HLA Mismatching Strategies for Solid Organ Transplantation - A Balancing Act. Frontiers in immunology. 2016;7:575-. doi: 10.3389/fimmu.2016.00575. PubMed PMID: 28003816.

Johnson RJ, Fuggle SV, O'Neill J, Start S, Bradley JA, Forsythe JL, et al. Factors influencing outcome after deceased heart beating donor kidney transplantation in the United Kingdom: an evidence base for a new national kidney allocation policy. Transplantation. 2010;89(4):379-86. Epub 2010/02/24. doi: 10.1097/TP.0b013e3181c90287. PubMed PMID: 20177338.

Abramowicz D, Cochat P, Claas FH, Heemann U, Pascual J, Dudley C, et al. European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant. 2015;30(11):1790-7. Epub 2014/07/11. doi: 10.1093/ndt/gfu216. PubMed PMID: 25007790.

Shi X, Lv J, Han W, Zhong X, Xie X, Su B, et al. What is the impact of human leukocyte antigen mismatching on graft survival and mortality in renal transplantation? A meta-analysis of 23 cohort studies involving 486,608 recipients. BMC Nephrol. 2018;19(1):116-. doi: 10.1186/s12882-018-0908-3. PubMed PMID: 29776389.

Targher G, Bertolini L, Zoppini G, Zenari L, Falezza G. Increased plasma markers of inflammation and endothelial dysfunction and their association with microvascular complications in Type 1 diabetic patients without clinically manifest macroangiopathy. Diabet Med. 2005;22(8):999-1004. doi: 10.1111/j.1464-5491.2005.01562.x. PubMed PMID: 16026364.

Parekh J, Bostrom A, Feng S. Diabetes mellitus: a risk factor for delayed graft function after deceased donor kidney transplantation. Am J Transplant. 2010;10(2):298-303. doi: 10.1111/j.1600-6143.2009.02936.x. PubMed PMID: 20055796.

Jushinskis J, Trushkov S, Bicans J, Suhorukov V, Shevelev V, Ziedina I, et al., editors. Risk factors for the development of delayed graft function in deceased donor renal transplants. Transplantation proceedings; 2009: Elsevier.

Sprung J, Kapural L, Bourke DL, O'Hara JF, Jr. Anesthesia for kidney transplant surgery. Anesthesiol Clin North Am. 2000;18(4):919-51. doi: 10.1016/s0889-8537(05)70202-9. PubMed PMID: 11094698.

Wagenaar S, Nederhoed JH, Hoksbergen AW, Bonjer HJ, Wisselink W, van Ramshorst GH. Minimally invasive, laparoscopic, and robotic-assisted techniques versus open techniques for kidney transplant recipients: a systematic review. European Urology. 2017;72(2):205-17.

de Souza DA, Silva FG, Costa PJ. Critical evaluation of justifications for the transfusion of red blood cells: the reality of a government emergency hospital. Rev Bras Hematol Hemoter. 2013;35(4):263-7. doi: 10.5581/1516-8484.20130070. PubMed PMID: 24106444; PubMed Central PMCID: PMCPMC3789431.

Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137(1):209-20. doi: 10.1378/chest.09-0252. PubMed PMID: 20051407.

Toy P, Gajic O, Bacchetti P, Looney MR, Gropper MA, Hubmayr R, et al. Transfusion-related acute lung injury: incidence and risk factors. Blood. 2012;119(7):1757-67. doi: 10.1182/blood-2011-08-370932. PubMed PMID: 22117051; PubMed Central PMCID: PMCPMC3286351.

Siemionow M, Agaoglu G. Role of blood transfusion in transplantation: a review. J Reconstr Microsurg. 2005;21(8):555-63. doi: 10.1055/s-2005-922436. PubMed PMID: 16292733.

Weeks SR, Luo X, Haugen CE, Ottmann SE, Gurakar AO, Naqvi FF, et al. Delayed Graft Function in Simultaneous Liver Kidney Transplantation. Transplantation. 2020;104(3):542-50. doi: 10.1097/TP.0000000000002908. PubMed PMID: 31403551; PubMed Central PMCID: PMCPMC7007338.

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Published

2021-05-01

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Research Article

How to Cite

1.
Kömürcü Özgür, Dost B, Dokmecı O, Gülşen M, Türkmen E, Tan B, Ulger F. Risk factors and consequences of delayed graft function in renal transplantation. J Surg Med [Internet]. 2021 May 1 [cited 2022 Aug. 8];5(5):478-81. Available from: https://jsurgmed.com/article/view/904358