title: Prediction, prevention, and management of delayed graft function: where are we now?
abstract: Delayed graft function (DGF) remains a major barrier to improved outcomes after kidney transplantation. High-risk transplant recipients can be identified, but no definitive prediction model exists. Novel biomarkers to predict DGF in the first hours post-transplant, such as neutrophil gelatinase-associated lipocalin (NGAL), are under investigation. Donor management to minimize the profound physiological consequences of brain death is highly complex. A hormonal resuscitation package to manage the catecholamine "storm" that follows brain death is recommended. Donor pretreatment with dopamine prior to procurement lowers the rate of DGF. Hypothermic machine perfusion may offer a significant reduction in the rate of DGF vs simple cold storage, but costs need to be evaluated. Surgically, reducing warm ischemia time may be advantageous. Research into recipient preconditioning options has so far not generated clinically helpful interventions. Diagnostic criteria for DGF vary, but requirement for dialysis and/or persistent high serum creatinine is likely to remain key to diagnosis until current work on early biomarkers has progressed further. Management centers on close monitoring of graft (non)function and physiological parameters. With so many unanswered questions, substantial reductions in the toll of DGF in the near future seem unlikely but concentrated research on many levels offers long-term promise.
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. nashan@uke.de.
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.affiliation: Department of Nephrology, Medical School FAMERP, Director Organ Transplantation Center Foundation FUNFARME, São José do Rio Preto, SP, Brazil.
authors.forename: Mario
authors.initials: M
authors.lastname: Abbud-Filho
authors.affiliation: Department of Surgery, Renal Transplantation, Catholic University, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Citterio
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D003661:Decision Support Techniques; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy; D006801:Humans; D016030:Kidney Transplantation; D009926:Organ Preservation / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods
chemical_list: D015415:Biomarkers
keywords: delayed graft function; diagnosis; hypothermic; immunosuppression; nephrectomy; normothermic; prediction; preservation; risk factors