Delayed graft function: a single center experience
Carlos Cobeñas1, Priscila Pereyra1, Laura Lombardi1, Maria Jose Gogorza1, Emanuel De Rose1, Sandy Chaparro1, Florencia Raffetto1, Ana Paula Spizzirri1, Javier Ruscasso1, Angela del Carmen Suarez1.
1Renal Transplant Unit; Nephrology department, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina
Introduction: Delayed graft function (DGF), defined as the need for dialysis in the first transplantation week, plays a role in the acute and chronic course in kidney transplantation.
Objectives: 1) to analyze the prevalence of DGF in our population of cadaveric grafts; 2) to evaluate risk factors and related conditions, and 3) to determine the long term outcome of patients who developed DGF.
Methods: we retrospectively evaluated patients with cadaveric grafts assisted from January 2002 to December 2021. We compared those with DGF and those without DGF. We evaluated donor and recipient age, vascular anastomosis and cold ischemia time, HLA matching, complications in the operating room (OR), renal biopsies, rejection episodes during the first year and graft function at last follow up. Statistic analysis was performed using chi-square. A p value <0.05 was considered statistically significant.
Results: we evaluated 100 patients. 36 patients developed DGF (36%, 21 male-58.3%) and 64 (64%, 29 male-45.3%) did not. Recipient age was 149 months (r: 48-208 m) in the DGF group, and 143,8 months (108-206 m) in the no DGF group. Donor age was 26.5 years in the DGF group (r: 8-52) and 21.3 years (r: 7-49). 7/35 donors in the DGF group were >40 years vs 6/61 in the no DGF group (p: 015). Cold ischemia time was 20.4 h (r: 10-30 h) in the DGF group and 19.6 h (r: 11-26 h) in the no DGF group. Cold ischemia time > 24 h was found in 10/36 (27.7 %) in the DGF group vs. 10/64 (15.6 %) in the no DGF group (p: 0.14). Vascular anastomosis time was 59.8 min (r: 15-120) in the DGF group vs. 55.8 min (r: 23-120) in the no DGF group. Regarding HLA matching, we divided patients in those with 2 and 3 or more matches. 21/36 patients in the DGF group had 2 matches (58.3 %) and 15 had 3 or more matches (41.7 %), vs 34/64 (53.1%9 and 30/64 (46.9%) in the no DGF group, respectively. Complications in the OR were seen in 16 patients in the DGF group (45.7 %) and 35 (45.4 %) in the no DGF group, being hypotension the most common in both. Renal biopsies were performed in 16/36 (44.4%) patients in the DGF group, and 14 (87.5 %) had findings of acute tubular necrosis, while only 2 patients were performed renal biopsies in the no DGF group. Rejection episodes during the first year were diagnosed in 16/36 (44,4%) patients in the DGF group and 15/64 (23.4 %) patients in the no DGF group (p: <0.03). Patients were followed for 32 months in the DGF group and 41.5 months in the no DGF group, and nonfunctioning kidneys were found in 4/36 (11,1%) in the DGF group and 7/63 (11,1 %) in the no DGF group.
Conclusion: 1) DGF was present in 36 % of our cadaveric grafts; 2) We did not observe relationship with donor and recipient age, cold ischemia and vascular anastomosis time, HLA matching, and complications in the OR, although donor age > 40 y could have relevance in this setting, although it must be evaluated in a larger cohort; ATN was the most frequent finding in renal biopsies in the DGF group and we detected significantly more rejection episodes in the DGF group; 3) At the last control, nonfunctioning kidneys were similar in both groups.
Renal Transplant Team, Hospital de Niños "Sup. Sor María Ludovica", La Plata, Argentina.
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