title: Risk factors for delayed graft function defined as need for dialysis or failure of creatinine to fall by 10% in the first 24 hours after transplant.
abstract: OBJECTIVE
  Delayed graft function after deceased-donor transplant remains a significant clinical problem. The conventional definition of delayed graft function is the requirement of dialysis within the first week after transplant, but this criterion has many problems that have led to many controversies including those of incidence and significance. Therefore, we sought to identify the possible risk factors of delayed graft function and to investigate their effect on short-term graft survival, according to a composite criterion.
  
  
  METHODS
  We reviewed the records of 94 renal transplants obtained from heart-beating deceased donors done at our center during a 2-year period. Variables related to the donor, recipient, and graft were retrospectively collected. Follow-up was 12 months. Delayed graft function was defined as the need for dialysis or the failure of the creatinine level to fall by 10% during the first 24 hours after transplant. To confirm suspected rejection, protocol biopsies were done, irrespective of graft function, on the seventh and 28th days after transplant, or when indicated to confirm suspected rejection.
  
  
  RESULTS
  The overall incidence of delayed graft function was 31.9%. Multivariate analysis showed donor age as a significant independent predictor of delayed graft function (OR=1.05, P = .03, 95% CI: 1.01-1.09), whereas donor hypotension was the only independent risk factor associated with a worse 1-year graft survival rate (OR=4.6, P = .021, 95% CI: 1.3-16.5). No association could be established between delayed graft function, acute rejection, and graft survival.
  
  
  CONCLUSIONS
  Advanced donor age is a predictor of delayed graft function defined as the need for dialysis or the failure of creatinine to fall by 10% during the first 24 hours after transplant. Preventing hemodynamic instability should be an important aspect of donor care.
authors.affiliation: Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom. harstrat@otenet.gr
authors.forename: Charalabos
authors.initials: C
authors.lastname: Stratopoulos
authors.forename: Ian Sd
authors.initials: IS
authors.lastname: Roberts
authors.forename: Jens
authors.initials: J
authors.lastname: Brockmann
authors.forename: Miguel
authors.initials: M
authors.lastname: Zilvetti
authors.forename: Anand
authors.initials: A
authors.lastname: Muthusamy
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sinha
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Friend
mesh_terms: D000367:Age Factors; D003404:Creatinine / Q000097:blood*; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D011183:Postoperative Complications; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003404:Creatinine