title: Delayed graft function is characterized by reduced functional mass measured by (99m)Technetium-mercaptoacetyltriglycine renography.
abstract: BACKGROUND
  The mechanism that underlies delayed graft function (DGF) is still poorly defined. Previous studies using tubular function tests have shown that postischemic injury to the renal transplants results in profound impairment of paraimmunohippurate (PAH) extraction through the tubules.
  
  
  METHODS
  Using (99m)Technetium-mercaptoacetyltriglycine ((99m)Tc-MAG3) renography and tubular function slope (TFS), a study of the tubular uptake of (99m)Tc-MAG3 was undertaken in a prospective study of renal transplant recipients with immediate graft function (IGF) and those with DGF.
  
  
  RESULTS
  A total of 37 consecutive recipients of a cadaveric graft and 5 kidneys from living donors was evaluated within 48 hours after transplantation and in week 2, months 3 and 6, and 3 years after transplantation. In addition to the protocol scans, recipients with DGF were examined every other day until function was resumed. Repeated measurement two-way analysis of variance and a change point analysis were performed to determine the difference in the follow-up of TFS values between the two groups. Fourteen patients were classified as having DGF and 28 immediate graft function. In the DGF group, the initial TFS value was significantly lower than in the immediate graft function group (0.54 [+/-0.01] and 1.75 [+/-0.16], respectively; P=0.002), a difference that persisted for up to 3 years. Change point analysis revealed that the postischemic tubular excretion improved with time in both groups in the first 3 to 4 weeks, but both groups remained different up to 3 years after transplantation. Multivariate analysis revealed that only the cold ischemic time was an independent risk factor for a low TFS value. After the initial recovery from postischemic injury, the TFS may be used as a marker for functional renal mass.
  
  
  CONCLUSIONS
  We propose that the tubular defect in DGF, as defined by (99m)Tc-MAG3 renography, is irreversible and may be a marker of initial graft function.
authors.affiliation: Department of Nephrology; Division of Nuclear Medicine, Department of Radiology; and Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tarek A F
authors.initials: TA
authors.lastname: El-Maghraby
authors.forename: Henk
authors.initials: H
authors.lastname: Boom
authors.forename: Jan A J
authors.initials: JA
authors.lastname: Camps
authors.forename: Koos A K
authors.initials: KA
authors.lastname: Blokland
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Leendert C
authors.initials: LC
authors.lastname: Paul
authors.forename: Ernest K J
authors.initials: EK
authors.lastname: Pauwels
authors.forename: Johan W
authors.initials: JW
authors.lastname: De Fijter
mesh_terms: D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D007684:Kidney Tubules / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011866:Radioisotope Renography; D017263:Technetium Tc 99m Mertiatide
chemical_list: D017263:Technetium Tc 99m Mertiatide; D016572:Cyclosporine