Delayed graft function: risk factors, consequences and parameters affecting outcome-results from MOST, A Multinational Observational Study.
BACKGROUND
Delayed graft function (DGF) is a common complication after renal transplantation, and may affect graft function. The aim of this analysis was to evaluate risk factors for DGF, as well as parameters and events influencing graft function after DGF. We analyzed data collected in an ongoing international, prospective; observational study, the Neoral-MOST (Multinational Observational Study in renal Transplantation), and included in the analysis all patients with cadaveric kidney transplants for whom renal function at 1 year posttransplantation was documented (N = 8950). Logistic regression was used to evaluate the risk factors for DGF occurrence, and multifactorial analysis of variance (ANCOVA) to assess the relevance of different factors for GFR at 1 year.


RESULTS
Higher donor age, longer CIT, male recipients, Caucasian recipients, high recipients body mass index, and PRA were all associated with a higher risk for DGF. Renal function of former DGF kidneys at 1 year was lower in kidneys of elder donors, or which had experienced rejection or CMV infection. Variations of the maintenance regimen at 1 year posttransplantation were not associated with better graft function. Multifactorial analysis showed donor age and acute rejection as significant independent factors.


CONCLUSIONS
Most factors increasing the risk for DGF or having a negative impact on renal function at 1 year in grafts with DGF are predetermined. Additional posttransplant damage by acute rejection was associated with further reductions in GFR. Preventing acute rejection is an important step in achieving optimal function of DGF grafts.
Lebranchu
Y
Y
CHU Tours, Hopital Bretonneau, Tours, France. lebranchu@med.univ-tours.fr
Halimi
J M
JM
Bock
A
A
Chapman
J
J
Dussol
B
B
Fritsche
L
L
Kliem
V
V
Oppenheimer
F
F
Pohanka
E
E
Salvadori
M
M
Soergel
M
M
Tufveson
G
G
D000328:Adult; D002102:Cadaver; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D014019:Tissue Donors
D007166:Immunosuppressive Agents; D016572:Cyclosporine