title: Delayed graft function decreases early and intermediate graft outcomes after expanded criteria donor kidney transplants.
abstract: Use of expanded criteria donors (ECD) has increased worldwide in previous years because of the donor scarcity. However, ECD are related to a greater risk of complications and shorter graft longevity. Delayed graft function (DGF) which impacts renal graft survival, represents one of the most common complications posttransplantation. The purpose of this study was to analyse DGF incidence among ECD kidneys and its role on early and intermediate recipient and graft survivals. We prospectively analyzed 46 ECD cases divided as group A (absence of DGF; n = 23) and B (DGF; n = 23). Group B was composed of older donors (P = .033) with longer cold ischemia times (P = .017), and greater incidences of acute rejection episodes (ARE) (P < .0001). Comparing group A with group B, we observed 1-year and 3-year overall recipient survivals to be 95.7% and 95.7% versus 91.3% and 91.3%, respectively (P = not significant). Censored 1-year and 3-year overall graft survivals were 100% and 92.9% versus 85.6% and 79.9%, respectively (P = .026). Analyzing the patients with DGF without (n = 9) versus with concomitant ARE (n = 14), no differences were noted in recipient and graft survivals. The incidence of DGF was strictly related to increased donor age, greater cold ischemia time, and presence of an ARE while DGF did not have a role in recipient survival, it reduced, graft survival. Concomitant ARE was not related to an impaired graft function.
authors.affiliation: Department of General Surgery and Organ Transplantation, La Sapienza University of Rome, Umberto I Policlinic of Rome, Rome, Italy. lai.quirino@libero.it
authors.forename: Q
authors.initials: Q
authors.lastname: Lai
authors.forename: R
authors.initials: R
authors.lastname: Pretagostini
authors.forename: L
authors.initials: L
authors.lastname: Poli
authors.forename: F
authors.initials: F
authors.lastname: Melandro
authors.forename: S
authors.initials: S
authors.lastname: Ferretti
authors.forename: F
authors.initials: F
authors.lastname: Della Pietra
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.forename: P B
authors.initials: PB
authors.lastname: Berloco
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D051799:Delayed Graft Function / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors