Delayed renal graft function – risk factors and impact on early posttransplant results

Poor kidney graft function in kidney transplantation (KT) is often associated with worse long-term outcomes. The aim of this study was to identify donor, graft and recipient risk factors associated with delayed graft function (DGF). This retrospective study includes all consecutive deceased donor kidney transplantation cases performed in Latvian Transplantation Center during the period from 01.01.2011 till 31.12.2012 (n=147). Exclusion criteria: deceased donor (DD) age > 55 years old, moderate or severe hypertension in DD anamnesis; recipients and donors younger than 18 years; recipients with 3rd and 4th KT; recipients PRA>10%; abnormal graft vascular or ureteral anatomy; surgical complications in early post-transplant period. After the selection procedure study included 80 transplantation cases from 58 deceased donors. All cases were divided into two groups: patients with primary graft function (PGF) (n=62), and patients with DGF (n=18). Groups were compared for the following factors: donor and recipient gender, age, weight, body mass index (BMI); donor HCT (as hydration marker) and cold ischemia time (CIT); serum creatinine concentration before transplantation and 1st,2nd,3rd, 4th,5th,7th,14th day after transplantation; diuresis amount ml from 1st till 14th day after transplantation. DGF was performed in 18cases (22.5%) and showed association with higher donor HCT (42.1±7.1% in DGF vs. 33.8±8.3% in PGF, p<0.05), recipient male gender (34% vs 13% in females, p<0.05) and recipient weight (82.7±14.4 kg in DGF vs. 70.9±13.5 kg in PGF, p<0.05. DGF was associated with higher CIT (22.7 ± 3.7 hrs in DGF vs. 17.8 ± 3.7 hrs in PGF, p<0.001). Prolonged cold ischemia time, recipient male gender and donor lower hydration level in pre-explantation period were associated with higher DGF rate. CIT and donor hydration level are those modifiable factors that can be improved in donor management and coordination logistics.