title: Risk factors and consequences of delayed graft function.
abstract: The impact of delayed graft function (DGF) on the outcome of renal transplantation remains controversial. We analyzed the risk factors for DGF and its impact on graft and patient survival. A total of 354 renal transplants performed between June 1986 and April 2000 were analyzed. Variables analyzed included donor and recipient age, method and duration of renal replacement therapy, HLA mismatch, cold and warm ischemia times, biopsy-confirmed acute rejection, length of stay in the hospital, serum creatinine at the end of first hospitalization as well as graft and patient survival at one, three, five and ten years. The study patients were divided into two groups: patients with DGF (G1) and those without DGF (G2). DGF occurred in 50 patients (14.1%), and it was seen more frequently in patients transplanted from deceased donors (60% vs. 40%, P <0.0001). The cause of DGF was acute tubular necrosis, seen in 98% of the cases. Univariate analysis showed a statistically significant difference between the two groups G1 and G2 in the following parameters: average duration on dialysis (52.3 vs. 36.4 months, P = 0.006), HLA mismatch (44.9% vs. 32.11% P = 0.015), donor age (35.9 vs. 40.2 years, P = 0.026), cold ischemia time (23 vs. 18.2 h, P = 0.0016), warm ischemia time (41.9 vs. 38.6 mn, P = 0.046), length of stay in the hospital during first hospitalization (54.7 vs. 33.2 days, P <0.0001), serum creatinine at the end of first hospitalization (140 vs. 112 μmol/L, P <0.0001) and at three months following transplantation (159 vs. 119 μmol/L, P = 0.0002). Multivariate analysis revealed the following independent risk factors for DGF: deceased donor (RR = 13.2, P <0.0001) and cold ischemia time (RR = 1.17, P = 0.008). The graft survival at one, three, five and ten years was 100%, 93%, 88.3% and 78.3% in G1 versus 100%, 95.9% 92.8% and 82.3% in G2; there was no statistically significant difference. The patient survival at one, three, five and ten years was 100%, 91.3%, 83.6% and 74.4% in G1 versus 100%, 95.9%, 94% and 82.6% in G2 with a statistically significant difference (P = 0.04). Prolonged cold ischemia time and transplantation of kidneys from deceased donors were the main risk factors for DGF in our study. Also, DGF significantly affected patient survival but had no influence on graft survival.
authors.affiliation: Department of Internal Medicine A, Charles Nicolle Hospital, Tunis, Tunisia. meji66@yahoo.fr
authors.forename: Mondher
authors.initials: M
authors.lastname: Ounissi
authors.forename: Mejda
authors.initials: M
authors.lastname: Cherif
authors.forename: Taieb Ben
authors.initials: TB
authors.lastname: Abdallah
authors.forename: Mongi
authors.initials: M
authors.lastname: Bacha
authors.forename: Hafedh
authors.initials: H
authors.lastname: Hedri
authors.forename: Ezzedine
authors.initials: E
authors.lastname: Abderrahim
authors.forename: Rym
authors.initials: R
authors.lastname: Goucha
authors.forename: Adel
authors.initials: A
authors.lastname: Kheder
authors.forename: Riadh Ben
authors.initials: RB
authors.lastname: Slama
authors.forename: Amine
authors.initials: A
authors.lastname: Derouiche
authors.forename: Mohamed
authors.initials: M
authors.lastname: Chebil
authors.forename: Rafika
authors.initials: R
authors.lastname: Bardi
authors.forename: Imen
authors.initials: I
authors.lastname: Sfar
authors.forename: Yosr
authors.initials: Y
authors.lastname: Gorgi
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D050377:Cold Ischemia / Q000009:adverse effects; D051799:Delayed Graft Function / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult