title: Delayed graft function is a syndrome rather than a diagnosis.
abstract: OBJECTIVE
  Delayed graft function is a significant prognostic indicator after renal transplantation. We hypothesized that delayed graft function is not a single entity, and different patterns of delayed graft function reflect various underlying pathological processes.
  
  
  METHODS
  An analysis of 762 renal transplants was performed, showing serum creatinine was charted serially for the first 30 days after transplant. Measurements were obtained: time on hemodialysis; time to peak creatinine; time for creatinine to half; time for creatinine to within 10% of baseline.
  
  
  RESULTS
  Four patterns of delayed graft function were identified. There was no association between pattern of delayed graft function, and 1-year graft survival or serum creatinine at 1 year. Time for creatinine to > 15 days was associated with a higher creatinine level at 1 year than it was with patients with time for creatinine to half < 5 days (300.6 ± 54.3 vs 211.3 ± 26.0 μmol/L; P < .01). Patients with 1-year creatinine concentrations > 180 μmol/L had longer time on hemodialysis and time for creatinine to half than did those with 1-year creatinine concentrations ≤ 180 μmol/L (9.2 ± 1.3 μmol/L vs 7.0 ± 0.7 μmol/L; P = .03; and 11.6 ± 1.7 μmol/L vs 6.0 ± 0.4 μmol/L; P < .001). Time for creatinine to half of 6.5 days (sensitivity 67.3%; specificity 79.4%; area under the curve, 0.70) was the best predictor of a 1-year creatinine concentration ≤ 180 μmol/L.
  
  
  CONCLUSIONS
  Delayed graft function is not a single entity; rather; it is the most common presentation of a heterogeneous variety of pathologies. Its rate of resolution of renal function is the best predictor of long-term graft outcome.
authors: From the Department of Renal Transplantation, Western Infirmary, Glasgow, Scotland.
authors: Emma
authors: E
authors: Aitken
authors: Claire
authors: C
authors: Cooper
authors: Niall
authors: N
authors: Dempster
authors: Michael
authors: M
authors: McDermott
authors: Carlo
authors: C
authors: Ceresa
authors: David
authors: D
authors: Kingsmore
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D006435:Renal Dialysis; D012189:Retrospective Studies; D013577:Syndrome; D009626:Terminology as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine