title: Cytomegalovirus mismatch as major risk factor for delayed graft function after pancreas transplantation.
abstract: BACKGROUND
  Risk factors for delayed graft function (DGF) in pancreas transplantation (PTx) and its implications on graft survival are poorly defined.
  
  
  METHODS
  Eighty-seven consecutive first-time PTx for type I diabetes performed between January 2003 and December 2007 were retrospectively reviewed. DGF was defined as a reversible need for exogenous insulin beyond postoperative day 10 (DGF group [DGFG]). For statistical analysis, DGFG patients were compared with patients with immediate graft function (control group [CG]).
  
  
  RESULTS
  DGF occurred in 16 patients (18.6%). C-peptide levels and DGF were inversely correlated (r=0.24, P=0.03). In univariate analysis, donor cytomegalovirus (CMV)+ antibody status, and D+/R- CMV mismatch were significantly associated with DGF (81.3% vs. CG 52.1%, P=0.029; and 62.5% vs. CG 21.1%, P=0.002, respectively). Compared with University of Wisconsin solution, histidine tryptophan ketoglutarate-preserved grafts displayed higher DGF rates (37.5% vs. CG 12.7%, P=0.030), similar to female recipients (DGFG 68.8% vs. CG 35.2%, P=0.015). On multivariate analysis, a significantly higher DGF incidence was noted in female recipients (DGFG 68.8% vs. CG 35.2%; P=0.03) and in recipients with D+/R- CMV mismatch (DGFG 62.5% vs. CG 21.1%; P=0.03). With a median follow-up of 40.4 months (range 0.7-74.2), graft survival at 5 years did not differ between both groups (94.4% CG vs. 93.8% DGFG; P=0.791).
  
  
  CONCLUSIONS
  This is the first study that identifies CMV mismatch (D+/R-) as an additional risk factor for DGF occurrence in PTx. In this particular cohort, DGF does not seem to affect graft survival.
authors: Center for Operative Medicine, Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors: Manuel
authors: M
authors: Maglione
authors: Matthias O
authors: MO
authors: Biebl
authors: Hugo
authors: H
authors: Bonatti
authors: Georg
authors: G
authors: Göbel
authors: Thomas
authors: T
authors: Ratschiller
authors: Stefan
authors: S
authors: Schneeberger
authors: Gerald
authors: G
authors: Brandacher
authors: Paul
authors: P
authors: Hengster
authors: Christian
authors: C
authors: Margreiter
authors: Nicole
authors: N
authors: Berger
authors: Raimund
authors: R
authors: Margreiter
authors: Johann
authors: J
authors: Pratschke
authors: Walter
authors: W
authors: Mark
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications*; D051799:Delayed Graft Function / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000401:mortality; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D002096:C-Peptide; D002097:C-Reactive Protein