Hypertension is an independent predictor of delayed graft function and worse renal function only in kidneys with chronic pathological lesions.
BACKGROUND
Delayed graft function (DGF) has been identified as one of the principal correlates of poor graft survival in cadaveric renal transplantation. However, its risk factors and clinical predictors have been poorly elucidated.


METHODS
We analyzed the risk factors of DGF with a specific emphasis on the role of histological damage of donor kidney. Then, we also studied the impact of DGF, and donor factors affecting DGF, on kidney graft function over the first year after engraftment in 100 consecutive cadaveric renal transplant (Tx) recipients.


RESULTS
The organs displaying DGF (n=48) had a significantly higher degree of glomerular sclerosis and tubular atrophy (P<0.01), as well as of interstitial fibrosis and vascular damage (P<0.02) in time-zero biopsies. In patients who received an "ideal" organ for Tx (total histological score < or = 4), DGF showed a strong relationship with Deltaage D-R (70% increase of risk for donors 10 years older than recipients), and with the histological score (odds ratio 1.34). In contrast, donor hypertension was the most relevant variable independently associated with DGF (odds ratio 19.4) in patients receiving a suboptimal organ (histological score >4). Moreover, DGF and donor hypertension adversely affected graft function at 1 year, but only in Tx patients with a histological score >4 in time-zero biopsy. Of note, both patients with and those without DGF showed a very low incidence of biopsy-proven acute rejection (8.5 and 6.8%, respectively) and a rather short cold ischemia time (<16 hr).


CONCLUSIONS
Our findings suggest that the quality of the transplanted organ and the occurrence of DGF are strictly related to each other and can influence graft function through apparently nonimmune mechanisms. In addition, long-standing donor hypertension is a strong independent variable affecting both DGF and graft function of suboptimal cadaveric kidneys, at least up to 1 year.
Di Paolo
Salvatore
S
Department of Emergency and Organ Transplant, Division of Nephrology, University of Bari, Policlinico, Piazza Giulio Cesare, 11-70124 Bari, Italy.
Stallone
Giovanni
G
Schena
Antonio
A
Infante
Barbara
B
Gesualdo
Loreto
L
Paolo Schena
Francesco
F
D000328:Adult; D001706:Biopsy; D002102:Cadaver; D002423:Cause of Death; D005355:Fibrosis / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome