medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2013, Number 2

Next >>

Rev Invest Clin 2013; 65 (2)

Risk factors in the development of delayed graft function in deceased donor kidney transplant recipients and their impact on patient and graft survival

Pérez-Gutiérrez A, Morales-Buenrostro LE, Vilatobá-Chapa M, Mendoza-De-la-Garza Á, Vega-Vega O, Gabilondo-Pliego B, Alberú J

Language: Spanish
References: 25
Page: 109-115
PDF size: 159.85 Kb.


ABSTRACT

Background. Delayed graft function (DGF) is an early complication of kidney transplant (KT) and it is related to a higher incidence of acute rejection (AR) and lower graft survival. The incidence of DGF ranges from 2 to 29% in different series. Several risk factors for DGF have been described, including inotropic use in the deceased donor, long cold ischemia time, cardiovascular brain death, age › 55 years, hypovolemia, previous transplant, preformed antibodies and OKT3 use. Material and methods. This study is a retrospective cohort of the kidney transplant recipients (KTR) of deceased donors from 1990 to 2009, at the INCMNSZ. We analyzed the incidence of DGF, risk factors associated to its development, and patient and graft outcome. To compare the groups, we used χ2 test or Student’s t test for categorical and numeric variables, respectively. Patient and graft survival were calculated using Kaplan- Meier method; a p value ‹ 0.05 was considered statistically significant. Results. Data from 105 KTR were analyzed. DGF occurred in 21%, AR in 27%, graft loss in 15.2%. The only risk factor associated to DGF was brain death due to vascular disease (p = 0.028). Conclusions. Brain death due to vascular disease was the only risk factor associated to DGF. A non-significant higher incidence of AR was observed in patients with DGF. Survival was significantly lower in patients who developed DGF compared to those without DGF, and it was not related to renal function.


REFERENCES

  1. Koning OHJ, Ploeg RJ, Van Bockel JH, et al. Risk factors for delayed graft function in cadaveric kidney transplantation. Transplantation 1997; 63: 1620-8.

  2. Cheung CY, Chan HW, Chan YH, et al. Impact of delayed graft function on renal function and graft survival in deceased kidney transplantation. Hong Kong Med J 2010; 16: 378-82.

  3. Perico N, Cattaneo D, Sayegh MH, et al. Delayed graft function in kidney tranplantation. Lancet 2004; 364: 1814-27.

  4. Halloran PF, Hunsicker LG. Delayed graft function: State of the art. Am J Transplant 2001; 1: 115-20.

  5. Lai Q, Pretagostini R, Poli L, et al. Early Urine Output Predicts Graft Survival After Kidney Transplantation. Transplant Proc 2010; 42(4): 1090-2.

  6. Premasathian N, Avihingsanon Y, Ingsathit A, et al. Risk Factors and Outcome of Delayed Graft Function after Cadaveric Kidney Transplantation: A Report from the Thai Transplant Registry. Transplant Proc 2010; 42(10): 4017-20.

  7. Kayler LK, Magliocca J, Zendejas TR, et al. Impact of cold ischemia on graft survival among ECD transplant recipients: a paired kidney analysis. Am J Transplant 2011; 11: 2647-56.

  8. Iglesias-Márquez RA, Santiago-Delpín EA, Zayas E, et al. Delayed graft function in kidney transplant recipients: risk factors and short-term outcome. Transplant Proc 2002; 34: 352-4.

  9. Nijboer WN, Moers C, Leuvenink HG, et al. How important is the duration of the brain death period for the outcome in kidney transplantation? Transpl Int 2011; 24: 14-20.

  10. Jung GO, Yoon MR, Kim SJ, et al. The Risk Factors of Delayed Graft Function and Comparison of Clinical Outcomes After Deceased Donor Kidney Transplantation: Single-Center Study. Transplant Proc 2010; 42(3): 705-9.

  11. Irisha WD, Ilsleyb JN, Schnitzler MA, et al. A Risk Prediction Model for Delayed Graft Function in the Current Era of Deceased Donor Renal Transplantation. Am J Transplant 2010; 10(10): 2279-86.

  12. The Organ Procurement and Transplantation Network. Available from: http://www. OPTN.org

  13. Troppman C, Gillingham KJ, Benedetti E, et al. Delayed graft function, acute rejection and outcome after cadaver renal transplantation. Transplantation 1995; 59: 962.

  14. Boom H, Mallat MJ, Fijter JW, et al. Delayed graft function influences renal function, but not survival. Kidney Int 2000; 58: 859.

  15. Serur D, Saal S, Wang J, et al. Deceased-donor kidney transplantation: improvement in long-term survival. Nephrol Dial Transplant 2011; 26(1): 317-24.

  16. Yarlagadda SG, Coca SG, Formica RN, et al. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transplant 2009; 24(3): 1039-47.

  17. Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant 2011; 11(11): 2279-96.

  18. Pfaff WW, Howard RJ, Patton PR, et al. Delayed graft function after renal transplantation. Transplantation 1998; 65: 219-23.

  19. Opelz G. Very short ischemia is not the answer. Nephrol Dial Transplant 2002; 17: 715-6.

  20. Kayler LK. Srinivas TR. Schold JD. Influence of CIT-Induced DGF on Kidney Transplant Outcomes. Am J Transplant 2011; 11: 2657-64.

  21. Ciancio G, Burke GW, Gaynor JJ, et al. A randomized trial of thymoglobulin versus alemtuzumab versus daclizumab in renal transplantation at 24 months of follow-up. Clin Transplant 2008; 22: 200-10.

  22. Takada M, Nadeau KC, Hancock WW, et al. Effects of explosive brain death on cytokine activation of peripheral organs in the rat. Transplantation 1998; 65: 1533-42.

  23. Pratschke J, Wilhelm MJ, Kusaka M, et al. Accelerated rejection of rat renal allografts from brain-dead donors. Ann Surg 2000; 232: 263-71.

  24. Meier-Kriesche HU, Baliga R, Kaplan B. Decreased renal function is a strong risk factor for cardiovascular death after renal transplantation. Transplantation 2003; 75(8): 1291-5.

  25. Australia and New Zealand Dialysis and Transplant Registry, 2008. Disponible en: http://www.anzdata.org.au/




2020     |     www.medigraphic.com