title: Delayed graft function and its management in children.
abstract: Delayed graft function (DGF) is commonly defined as the requirement for dialysis within the first 7 days following renal transplantation. The major underlying mechanism is related to ischaemia/reperfusion injury, which includes microvascular inflammation and cell death and apoptosis, and to the regeneration processes. Several clinical factors related to donor, recipient and organ procurement/transplantation procedures may increase the risk of DGF, including donor cardiovascular instability, older donor age, donor creatinine concentration, long cold ischaemia time and marked body mass index of both the donor and recipient. Some of these parameters have been used in specific predictive formulas created to assess the risk of DGF. A variety of other pre-, intra- and post-transplant clinical factors may also increase the risk of DGF, such as potential drug nephrotoxicity, surgical problems and/or hyperimmunization of the recipient. DGF may decrease the long-term graft function, but data on this effect are inconsistent, partially due to the many different types of organ donation. Relevant management strategies may be classified into the classic clinical approach, which has the aim of minimizing the individual risk factors of DGF, and specific pharmacologic strategies, which are designed to prevent or treat ischaemia/reperfusion injury. Both strategies are currently being evaluated in clinical trials.
authors: Department of Nephrology & Kidney Transplantation, The Children's Memorial Health Institute, Warsaw, Poland. r.grenda@czd.pl.
authors: Ryszard
authors: R
authors: Grenda
mesh_terms: D000367:Age Factors; D064591:Allografts / Q000187:drug effects / Q000503:physiopathology*; D015992:Body Mass Index; D002648:Child; D050377:Cold Ischemia / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000209:etiology / Q000628:therapy*; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D015427:Reperfusion Injury / Q000150:complications*; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D009927:Tissue and Organ Procurement / Q000379:methods; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D003404:Creatinine
keywords: Clinical risk factors; Delayed graft function; Ischaemia/reperfusion injury; Outcome; Prevention