Influence of allocation factors on deceased donor kidney graft function in early posttransplant period

Poor kidney graft function in kidney transplantation (KT) is often associated with worse long-term outcomes. The aim of this study was to identify impact of allocation factors on kidney graft functional indicators in early period after KT. This retrospective study included all consecutive deceased donor (DD) KT cases performed in one transplantation centre during the period from 01.01.2011 till 31.12.2012 (n=147). Exclusion criteria were: DD age > 55 years old and moderate or severe hypertension in anamnesis; recipients and donors age < 18 years; recipients of 3rd or 4th KT; recipient PRA>10%; abnormal graft anatomy; induction immunosuppression by ATG; surgical complications in early post-transplant period. After selection study included 80 KT cases from 58 DD. We analysed impact of cold ischemia time (CIT), recipient BMI, donor-recipient BMI matching and need for dialysis immediately before KT on the following kidney graft function indicators: serum creatinine (s-Crea) concentration before transplantation and during the first week and day 14 after KT; s-Crea reduction ratio at 1st, 7th and 14th postransplant days; 24 hours fluid intake and diuresis volumes during 14 days after KT; incidence of delayed graft function (DGF). Poor graft function and higher DGF rate was associated with CIT > 20 hours (observed in 27.5%, p<0.05), recipient BMI > 30 kg/m2 (observed 13.7%, p<0.05), need for HD immediately before transplantation (performed in 20 cases (25%), p<0.05). Donor BMI higher than recipient BMI more than 5 kg/m2 was observed in 20 cases (25%) and associated with better transplant outcomes (P<0.05). Cold ischemia time more than 20 hours, recipient obesity, recipient HD before transplant showed association with a poor kidney graft function and higher DGF rate. Allocation of kidneys from donors with higher BMI into recipients with lower BMI may improve early KT results.