Delayed Graft Function: Risk Factors and the Effects of Early Function and Graft Survival

作者：Miglinas M^*; Supranaviciene L; Mateikaite K; Skebas K; Kubiliene A

来源：Transplantation Proceedings, 2013, 45(4): 1363-1367.

DOI：10.1016/j.transproceed.2013.03.014

Introduction. Delayed graft DGF), a well-known immediate postoperative complication is defined as the need for dialysis during the first week after deceased donor kidney transplantation. It affects 25% to 50% of recipients. In this study we identified risk factors for DGF and its impact on patient and graft survivals. %26lt;br%26gt;Methods. We retrospectively analyzed medical records from renal transplant recipients aged above 18 years who received a deceased donor kidney graft between November 2008 and December 2011, excluding kidney losses during the first week. %26lt;br%26gt;Results. Among 137 transplantations, 64 (46.5%) displayed DGF. Multivariate analysis showed secondary renal disease (OR 3.7, CI 1.36-10.30; P = .011), HLA mismatches %26gt; 3 (OR 4.4, CI 1.53-12.51; P = .006) and donor urine output %26lt;= 3000 ml/24h (OR 25.8, CI 3.60-185.70; P = .001) to be significant risk factors for DGF. The hospitalization time was longer in the DGF group (38,2 +/- 20,75 vs. 25,6 +/- 8,18; P %26lt; .001). At 1 month, DGF group showed worse graft function based upon serum creatinine: 207.7 +/- 148.52 vs 118.1 +/- 36.63 mu mol/L (P %26lt; .001). At 1 year follow-up, incidence of biopsy-proven acute renal rejection episodes was higher in the DGF (28; 51,9%) vs. the non-DGF group (18; 33,3%; P = .05). The 1-year recipient survival in DGF and no DGF groups were 90% vs 97% respectively (P = .124). With 1-year death censored graft survivals of 92% vs 100% respectively (P = .062). %26lt;br%26gt;Conclusion. Secondary renal disease, HLA mismatches and lower donor urinary output were associated with a greater incidence of DGF, leading to prolonged hospitalizations and an increased risk for an acute rejection episode.

• 出版日期2013-5