title: Delayed graft function has an equally bad impact on deceased donor renal graft survival in both standard criteria donors and expanded criteria donors.
abstract: BACKGROUND
  The use of expanded criteria donors (ECDs) is still limited because of inferior graft survival compared to standard criteria donors (SCDs). We assessed the impact of immediate graft function (IGF) on renal graft survival among recipients of SCD and ECD grafts to determine whether these kidneys performed equally well under "ideal" conditions favoring IGF.
  
  
  METHODS
  We included all cadaveric renal transplants performed from 1990 to 2002 (n = 335). Delayed graft function (DGF) was defined as the need for dialysis in the first 7 days posttransplant. Slow graft function (SGF) and IGF were defined as a serum creatinine fall by <20% versus >20% in the first 24 hours posttransplant, respectively. Non-death censored actual graft survivals are reported herein.
  
  
  RESULTS
  Seventy-two of the 335 subjects (21.5%) received organs from ECDs and displayed IGF in 54.7%, SGF 16.2%, and DGF 29.1%. Among SCDs, the SGF and DGF rates were 15.3% and 23.4%, respectively. In ECD, the SGF and DGF rates were 19.4% and 50% (P < .02). Actual graft survivals at 1 and 5 years was 86.3% and 70.4%, respectively. Patients with IGF had higher actual graft survival at 5 years compared to SGF and DGF (83.5% vs 74.1% vs 45.4%). DGF had an equally bad impact on actual 5-year graft survival in SCDs and ECDs (42.6% vs 50%).
  
  
  CONCLUSIONS
  DGF has a strong detrimental impact on 5-year graft survival. There is a higher rate of DGF in ECD versus SCD kidneys. The detrimental impact on 5-year actual graft survival is equal in SCD and ECD kidneys. Minimizing DGF should be our goal.
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada. mazen.hassanain@email.mcgill.ca
authors.forename: M
authors.initials: M
authors.lastname: Hassanain
authors.forename: J
authors.initials: J
authors.lastname: Tchervenkov
authors.forename: M
authors.initials: M
authors.lastname: Cantarovich
authors.forename: P
authors.initials: P
authors.lastname: Metrakos
authors.forename: S
authors.initials: S
authors.lastname: Paraskevas
authors.forename: D
authors.initials: D
authors.lastname: Keith
authors.forename: D
authors.initials: D
authors.lastname: Baran
authors.forename: M
authors.initials: M
authors.lastname: Fernandez
authors.forename: R
authors.initials: R
authors.lastname: Mangel
authors.forename: P
authors.initials: P
authors.lastname: Chaudhury
mesh_terms: D002102:Cadaver; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine