Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Abstract

Background. Delayed graft function is a frequent complication of kidney transplantation that requires dialysis in the first week posttransplant. Materials and Methods. We searched for the most relevant articles in the National Institutes of Health library of medicine, as well as in transplantation, pharmacologic, and nephrological journals. Results. The main factors that may influence the development of delayed graft function (DGF) are ischemia–reperfusion injury, the source and the quality of the donated kidney, and the clinical management of the recipient. The pathophysiology of ischemia–reperfusion injury is complex and involves kidney hypoxia related to the duration of warm and cold ischemia, as well as the harmful effects of blood reperfusion on tubular epithelial cells and endothelial cells. Ischemia–reperfusion injury is more frequent and severe in kidneys from deceased donors than in those from living donors. Of great importance is the quality and function of the donated kidney. Kidneys from living donors and those with normal function can provide better results. In the peri-operative management of the recipient, great attention should be paid to hemodynamic stability and blood pressure; nephrotoxic medicaments should be avoided. Over time, patients with DGF may present lower graft function and survival compared to transplant recipients without DGF. Maladaptation repair, mitochondrial dysfunction, and acute rejection may explain the worse long-term outcome in patients with DGF. Many different strategies meant to prevent DGF have been evaluated, but only prolonged perfusion of dopamine and hypothermic machine perfusion have proven to be of some benefit. Whenever possible, a preemptive transplant from living donor should be preferred.

Early post‐operative lactate increase following kidney transplant is associated with delayed graft function: A retrospective cohort study

“…To our knowledge, these results have never been described before. Interestingly, our results confirmed that factors like high donor age, elevated ischemia cold time, and high dose of norepinephrine during kidney transplant could have on impact on kidney outcome and also with the occurrence of DGF 24–29 . However, we did not find a link between hyperlactatemia and patients’ outcome, objective by 7‐day post‐operative complications.…”

“…Interestingly, our results confirmed that factors like high donor age, elevated ischemia cold time, and high dose of norepinephrine during kidney transplant could have on impact on kidney outcome and also with the occurrence of DGF. [24][25][26][27][28][29] How-ever, we did not find a link between hyperlactatemia and patients'…”

Pitfalls in Valganciclovir Prophylaxis Dose Adjustment Based on Renal Function in Kidney Transplant Recipients

“…Inappropriate VGC dosing included underdosing and overdosing, defined as any dose below and above the predetermined eGFR ranges, respectively. Inappropriate dosing can be influenced by an early graft dysfunction, such as a delayed graft function (DGF), defined as an acute kidney injury (AKI) which occurs in the first week after transplantation or a primary non function (PNF), defined as permanent lack of graft function from the time of transplantation, both requiring a dialysis treatment [ 13 , 14 ]. CMV infection and disease were defined based on international guidelines [ 15 ].…”

Research Highlights

“…The need for renal replacement therapy would fulfill the definition of delayed graft function 2 and predict inferior long-term graft and recipient survival. 3 Because immediate posttransplant graft dysfunction is largely driven by organ ischemia–reperfusion injuries, 4 it would be highly interesting to combine this approach with measures that attenuate ischemia–reperfusion injuries.…”