title: Effects of ischemia-reperfusion injury in kidney transplantation: risk factors and early and long-term outcomes in a single center.
abstract: BACKGROUND
  Ischemia-reperfusion injury (IRI) causes a high rate of delayed graft function (DGF), the most frequent complication in the immediate postoperative period after cadaveric donor kidney transplantation. Herein we evaluated the impact of donor and recipient characteristics on DGF development in terms of the incidence of acute rejection episodes, hospital stay, renal function, and long-term graft and patient survivals.
  
  
  METHODS
  Between February 1998 and July 2011, 761 patients underwent cadaveric donor kidney transplantations. DGF was defined as the need for dialysis in the first week. Patients were subdivided according to initial graft function as immediate graft function (IGF) or DGF.
  
  
  RESULTS
  DGF observed in 241 patients (31.6%) was associated independently with expanded criteria donors, extended cold ischemia time, Karpinsky histological score, and prior dialysis duration both univariate and multivariate analysis. The incidence of acute rejection episodes was 18.1% among the DGF group versus 1.3% in the IGF group (P < .01). DGF significantly reduced both graft and patient survivals at 6, 12, 36, and 60 months.
  
  
  CONCLUSIONS
  DGF was responsible for a longer hospital stay, worse early and long-term renal function, a higher incidence of acute rejection episodes as well as reduced graft and patient survivals.
authors.affiliation: Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Ditonno
authors.forename: S V
authors.initials: SV
authors.lastname: Impedovo
authors.forename: S
authors.initials: S
authors.lastname: Palazzo
authors.forename: C
authors.initials: C
authors.lastname: Bettocchi
authors.forename: L
authors.initials: L
authors.lastname: Gesualdo
authors.forename: G
authors.initials: G
authors.lastname: Grandaliano
authors.forename: F P
authors.initials: FP
authors.lastname: Selvaggi
authors.forename: M
authors.initials: M
authors.lastname: Battaglia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D016030:Kidney Transplantation; D015427:Reperfusion Injury; D012307:Risk Factors; D016896:Treatment Outcome