title: Delayed graft function after renal transplantation: an unresolved problem.
abstract: Unlike other areas in renal transplantation, delayed graft function (DGF) remains an apparently unavoidable complication owing to the characteristics of current donors. The aim of this study was to analyze risk factors for DGF in relation to graft and patient survivals. We retrospectively analyzed 507 renal transplant recipients with a median follow-up of 74.83 ± 45.06 months. DGF, which occurred among 189 patients (36.8%) was defined as requirement for dialysis within the first week after transplantation. Donor (P = .000) and recipient (P = .000) age were greater in the DGF group without differences in recipient or donor gender, HLA sensitization, or dialysis time before transplantation. Donor factors as the cause of death associated with DGF were secondary cerebrovascular stroke (P = .002) and hypertensive history (P = .000). Recipient characteristics associated therewith were higher body mass index (P = .000), smoking habit (P = .003), ischemic cardiopathy (P = .01), and dyslipidemia (P = .05). Moreover, the DGF group showed longer cold ischemia (P = .01) and vascular anastomosis (P = .02) times. On multivariate analysis, recipient age (P = .00) and smoking habit (P = .01) together with a donor history of hypertension (P = .02) were independent risk factors for DGF. No differences were observed in acute rejection incidence (P = .07) with worse renal function during follow-up (P < .05). Graft (81% vs 88%; P = .00) and patient (89% vs 95%; P = .00) survivals at 5 years were lower among the DGF group. In conclusion, DGF which was associated with factors related to the donor, the recipient, and the surgical times, produced worse graft and patient survivals. Shortening the cold ischemia time seems to be a modifiable variable to reduce DGF.
authors.affiliation: Servicio de Nefrología, Hospital U. Dr Peset, Valencia, Spain. egavelam@senefro.org
authors.forename: E
authors.initials: E
authors.lastname: Gavela Martínez
authors.forename: L M
authors.initials: LM
authors.lastname: Pallardó Mateu
authors.forename: A
authors.initials: A
authors.lastname: Sancho Calabuig
authors.forename: S
authors.initials: S
authors.lastname: Beltrán Catalán
authors.forename: J
authors.initials: J
authors.lastname: Kanter Berga
authors.forename: A I
authors.initials: AI
authors.lastname: Ávila Bernabeu
authors.forename: J
authors.initials: J
authors.lastname: Crespo Albiach
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D050377:Cold Ischemia / Q000009:adverse effects; D051799:Delayed Graft Function / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000401:mortality; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult