A pair analysis of the delayed graft function in kidney recipient: the critical role of the donor.
OBJECTIVE
The aim of this study was to analyze the importance of donor factors and especially the potential role of hemodynamic management in regard to delayed graft function in paired kidney recipient patients after renal transplantation and to analyze the urine of organ donors by proton-nuclear magnetic resonance spectroscopy to identify urine markers potentially correlated with delayed graft function in recipient patients.


METHODS
A prospective multicenter epidemiologic study was conducted. A logistic regression model taking into account paired data was used.


RESULTS
Data from 72 donors and the 144 corresponding paired recipients were analyzed. Univariate analysis showed that age of donor, previous history of tobacco, ischemic cause of brain death, norepinephrine infusion, and recipient age were the risk factors for delayed graft function. After adjusting for correlated outcome data and controlling for other potential prognostic factors, 3 variables remained significantly associated with outcome: donor age (odds ratio [OR], 10.7), hemodynamic status (OR, 0.167), and hydroxyl-ethyl starch infusion (OR, 0.135). Proton-nuclear magnetic resonance analysis evidenced 3 metabolites of interest in donors (trimethylamine-N-oxide, citrate, and lactate). However, these peaks were not correlated the clinical parameters in donors.


CONCLUSIONS
Paired analysis of kidney transplantation emphasizes the important role of factor donor associated with delayed graft function in recipient. Thus, a particular attention should be paid to the hemodynamic management of donor.
Robert
René
R
INSERM Unité 927 CHU Poitiers, 86021 Poitiers, France. r.robert@chu-poitiers.fr
Guilhot
Joëlle
J
Pinsard
Michel
M
Longeard
Pol-Louis
PL
Jacob
Jean-Paul
JP
Gissot
Valérie
V
Hauet
Thierry
T
Seguin
François
F
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000652:urine; D001926:Brain Death; D002648:Child; D019343:Citric Acid / Q000652:urine; D051799:Delayed Graft Function / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016030:Kidney Transplantation / Q000502:physiology*; D019344:Lactic Acid / Q000652:urine; D016015:Logistic Models; D008297:Male; D008744:Methylamines / Q000652:urine; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D055815:Young Adult
D015415:Biomarkers; D008744:Methylamines; D019343:Citric Acid; D019344:Lactic Acid; C005855:trimethyloxamine