title: The prognostic value of time needed on dialysis in patients with delayed graft function.
abstract: BACKGROUND
  We hypothesize that in patients with delayed graft function (DGF), the need for a longer time needed on dialysis (TND) post-kidney transplant is associated with poorer long-term function and an increase in complications.
  
  
  METHODS
  This was a retrospective chart review involving collaboration between Western University (WU) Renal Transplant Program of London, Ontario and the Saskatchewan renal transplant program (SRTP). A total of 774 patients (567 WU and 207 SRTP) received kidney transplants between 2004 and 2011, of which 83 patients with deceased donor transplants (59 WU and 24 SRTP) developed DGF, defined as the need for dialysis in the first week posttransplant.
  
  
  RESULTS
  Patients with DGF were divided into three groups depending on TND [group 1: <7 days (n = 52), group 2: 7-14 days (n = 13) and group 3 (n = 18): >14 days]. The creatinine clearance (CrCl) at 30 days (42.5, 33.8, 20.0 cc/min; P < 0.001) and 1 year (56.7, 49.2, 37.3 cc/min, P = 0.031) were significantly different between the three groups. Multivariate regression analysis identified length of TND posttransplant (β = -0.5, P < 0.001) and donation after cardiac death (DCD) donor (β = 19.5, P < 0.001) as the most significant predictors of CrCl at 1 year in these patients with DGF. DCD kidneys with DGF had a higher CrCl at 1 year and fewer readmissions in the first year compared with non-DCD kidneys with DGF.
  
  
  CONCLUSIONS
  Our study suggests that increased TND is associated with worse CrCl at 1 year. The data also support the hypothesis of a different mechanism for DGF in DCD and non-DCD kidneys.
authors.affiliation: Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Marek
authors.forename: Benjamin
authors.initials: B
authors.lastname: Thomson
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shoker
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Luke
authors.forename: Michael A J
authors.initials: MA
authors.lastname: Moser
mesh_terms: D000328:Adult; D003404:Creatinine / Q000378:metabolism; D003643:Death; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D011184:Postoperative Period; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine
keywords: delayed graft function; dialysis; kidney transplantation; prognosis; time needed on dialysis