Outcomes of delayed graft function in deceased donor kidney transplantation: a single center experience

Year 2021, Volume: 4 Issue: 1, 109 - 114, 21.01.2021

Özgür Merhametsiz , Mehmet Emin Demir

https://doi.org/10.32322/jhsm.856308

Abstract

Objective: Delayed graft function (DGF) is related to enhanced acute rejection attacks in the short term and reduced graft survival and reduced overall survival in the long-term. In this study, we desired to ascertain the outcomes of DGF.
Material and Methods: This study is a retrospective cohort study. Two hundred seventy-four patients who underwent a kidney transplant from a deceased donor were included. DGF was described as obtaining dialysis treatment within the first week of transplant. The kidney recipients were divided into groups DGF+ (Group 1) and DGF- (Group 2). Two groups were compared in terms of risk factors which were based on donor and recipient characteristics. Short-term outcomes, long-term graft survival and recipient survival results were compared.
Results: The incidence of DGF was 50.3%. The rate of donors with expanded criteria donor (ECD) was 37.3%. Mean glomerular filtration rate (GFR) at one year after kidney transplantation was 57.5 ml/dk/1.73m2 for Group 1, and 73 ml/dk/1.73m2 for Group 2 (p<0.001). There was no statistically significant difference between the groups in terms of graft loss and mortality at one year. There was no statistically significant difference between groups in terms of graft and recipient survival.
Conclusion: DGF did not negatively impact graft survival and recipient survival at one year and long-term, although it was associated with prolonged hospitalization and increased acute rejection in the early period.

Keywords

Delayed graft function, kidney transplantation, graft survival

References

• Wang CJ, Wetmore JB, Israni AK. Old versus new: progress in reaching the goals of the new kidney allocation system. Hum Immunol 2017; 78: 9–15.
• Samoylova ML, Nash A, Kuchibhatla M, Barbas AS, Brennan TV. Machine perfusion of donor kidneys may reduce graft rejection. Clin Transplant 2019; 33: e13716.
• Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant 2011; 11: 2279–96.
• Bahl D, Haddad Z, Datoo A, Qazi YA. Delayed Graft Function in Kidney Transplantation. Curr Opin Organ Transplant 2019; 24: 82-6.
• 5.Yarlagadda SG, Coca SG, Formica Jr RN, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systemic review and meta-analysis. Nephrol Dial Transplant 2009; 24: 1039e47.
• Lai Q, Pretagostini R, Poli L, et al. Delayed graft function decreases early and intermediate graft outcomes after expanded criteria donor kidney transplants. Transplant Proc 2009; 41: 1145-8.
• Helfer MS, Pompeo JC, Costa ORS, Vicari AR, Ribeiro AR, Manfro RC. Longterm effects of delayed graft function duration on function and survival of deceased donor kidney transplants. J Bras Nefrol 2019; 41: 231-41.
• Tapiawala SN, Tinckam KJ, Cardella CJ, et al. Delayed graft function and the risk for death with a functioning graft. J Am Soc Nephrol 2010; 21: 153-61.
• Lim WH, McDonald SP, Russ GR, et al. Association between delayed graft function and graft loss in donation after cardiac death kidney transplants-a paired kidney registry analysis. Transplantation 2017 ; 101: 1139-43.
• Melih KV, Boynuegri B, Mustafa C, Nilgun A. Incidence, risk factors,and outcomes of delayed graft function in deceased donor kidney transplantation. Transplant Proc 2019; 51: 1096-100.
• Boom H, Mallat MJ, de Fijter JW, Zwinderman AH, Paul C. Delayed graft function influences renal function, but not survival. Kidney Int 2000; 58: 859-66.
• Mannon RB. Delayed Graft Function: The AKI of Kidney Transplantation. Nephron 2018; 140: 94-8.
• Port FK, Bragg-Gresham JL, Metzger RA, et al. Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation 2002; 74: 1281–6.
• Emiroğlu R, Yagmurdur MC, Karakayali F, et al. Role of donor age and acute rejection episodes on long-term graft survival in cadaveric kidney transplantations. Transplant Proc 2005; 37: 2954-6
• Sert I, Colak H, Tugmen C, Dogan SM, Karaca C. The effect of cold ischemia time on delayed graft function and acute rejection in kidney transplantation. Saudi J Kidney Dis Transpl 2014; 25: 960-6.
• Uysal E, Gurer OA, Yuzbasioglu MF, Guzel H, Ulutasdemir N, Dokur M. Evaluation of renal transplantations performed in the Transplantation Center at Sanko University Medical School. Transplant Proc 2015; 47: 1117-21.
• Yazici B, Oral A, Gokalp C, Akgün A, Toz H, Hoscoskun C. A new quantitative index for baseline renal transplant scintigraphy with 99mTc-DTPA in evaluation of delayed graft function and prediction of 1-year graft function. Clin Nucl Med 2016; 41: 182-8.
• Tugmen C, Sert I, Kebabcı E, et al. delayed graft function in kidney transplantation: risk factors and impact on early graft function. Prog Transplant 2016; 26: 172-7
• Hamed MO, Chen Y, Pasea L, et al. Early graft loss after kidney transplantation: risk factors and consequences. Am J Transplant 2015; 15:1632-43.
• Park WY, Choi MS, Kim YS, et al. Impact of acute kidney injury in expanded criteria deceased donors on post-transplant clinical outcomes: multicenter cohort study. BMC Nephrol 2019; 20: 39.
• Kwon JA, Park H, Park SJ, et al. Factors of acute kidney injury donors affecting outcomes of kidney transplantation from deceased donors.Transplant Proc 2019; 51: 2575-81.
• Foroutan F, Friesen EL, Clark KE, et al. Risk factors for 1-year graft loss after kidney transplantation: systematic review and meta-analysis. Clin J Am Soc Nephrol 2019; 14: 1642-50.
• Renkens JJ, Rouflart MMJ, Christiaans MHL, van den Berg-Loonen EM , van Hooff JP, van Heurn LW. Outcome of nonheart-beating donor kidneys with prolonged delayed graft function after transplantation. Am J Transplant 2005; 5: 2704-9.
• Lim WH, Johnson DW, Teixeira-Pinto A, Wong G. Association between duration of delayed graft function, acute rejection, and allograft outcome after deceased donor kidney transplantation. Transplantation 2019; 103: 412-9.