title: Significance of delayed graft function in cyclosporine-treated recipients of cadaver kidney transplants.
abstract: Many transplant teams are reluctant to initiate cyclosporine immunosuppression in recipients of cadaver kidney grafts with delayed graft function (DGF). The renal function of cadaver kidney grafts in cyclosporine-treated recipients was compared in 47 recipients with DGF and 57 without DGF. Regardless of initial renal function, all recipients received prednisone, azathioprine, and oral cyclosporine 5 mg/kg/day or its intravenous equivalent. All kidneys were flushed with ice-cold intracellular electrolyte solution and cold-stored for 15-54 hr (mean of 31 hr) prior to transplantation at our hospital between April 10, 1985 and November 30, 1986. Rejection crises were treated with high-dose steroids or OKT3. Cyclosporine was discontinued during courses of OKT3. Recipients with DGF had significantly higher one-month serum creatinine nadirs (2.6 +/- 1.8 mg/dl vs. 1.5 +/- 0.5 mg/dl). Actuarial graft survivals were not significantly different at one year (82.2 +/- 5.5% vs. 82.6 +/- 6.4%, all graft losses included). Mean serum creatinine levels at six months and twelve months after grafting were not significantly different (1.7 +/- 0.4 mg/dl vs. 1.8 +/- 1.2 mg/dl and 2.0 +/- 0.5 vs. 1.7 +/- 0.7 mg/dl, respectively). Delayed graft function following cadaver kidney transplantation does not adversely affect intermediate term function of kidney grafts flushed with intracellular electrolyte solution and cold-stored until transplantation when a low-dose cyclosporine induction protocol is used and cyclosporine is discontinued during OKT3 administration.
authors.affiliation: Renal Transplant Service, Oregon Health Sciences University, Portland 97201.
authors.forename: J M
authors.initials: JM
authors.lastname: Barry
authors.forename: N
authors.initials: N
authors.lastname: Shively
authors.forename: B
authors.initials: B
authors.lastname: Hubert
authors.forename: T
authors.initials: T
authors.lastname: Hefty
authors.forename: D J
authors.initials: DJ
authors.lastname: Norman
authors.forename: W M
authors.initials: WM
authors.lastname: Bennett
mesh_terms: D002102:Cadaver; D003404:Creatinine / Q000097:blood*; D003524:Cyclosporins / Q000627:therapeutic use*; D004231:Diuresis; D004334:Drug Administration Schedule; D006084:Graft Rejection / Q000187:drug effects; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000503:physiopathology
chemical_list: D003524:Cyclosporins; D003404:Creatinine