Modifiable Risk Factors for Delayed Graft Function After Deceased Donor Kidney Transplantation

Abstract

Purpose: Delayed graft function is a major complication after kidney transplantation affecting patients’ long-term outcome. The aim of this study was to identify modifiable risk factors for delayed graft function after deceased donor kidney transplantation. Methods: This is a single-center retrospective cohort study of a university transplantation center. Univariate and multivariate step-wise logistic regression analysis of patient-specific and procedural risk factors were conducted. Results: We analyzed 380 deceased donor kidney transplantation patients between October 30, 2008 and December 30, 2017. The incidence of delayed graft function was 15% (58/380). Among the patient-specific risk factors recipient diabetes (2.8 [1.4-5.9] odds ratio [OR] [95% confidence interval [CI]]), American Society of Anesthesiologist score of 4 (2.7 [1.2-6.5] OR [95% CI]), cold ischemic time >13 hours (2.8 [1.5-5.3] OR [95% CI]) and donor age >55 years (1.9 [1.01-3.6] OR [95% CI]) revealed significance. The significant intraoperative, procedural risk factors included the use of colloids (3.9 [1.4-11.3] OR [95% CI]), albumin (3.0 [1.2-7.5] OR [95% CI]), crystalloids >3000 mL (3.1 [1.2-7.5] OR [95% CI]) and mean arterial pressure <80 mm Hg at the time of reperfusion (2.4 [1.2-4.8] OR [95% CI]). Conclusion: Patients undergoing deceased donor kidney transplantation with a mean arterial pressure >80 mm Hg at the time of transplant reperfusion without requiring excessive fluid therapy in terms of colloids, albumin or crystalloids >3000 mL are less likely to develop delayed graft function.

Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

“…Our data are closely related to those reported by Gingell-Littlejohn et al [11] and Kaufmann et al [9]. Both studies identified a correlation between intraoperative MBP and DGF occurrence, despite targets and cut-offs varied between studies [any recorded MBP<70 mmHg and an MBP <80 mm Hg at the time of reperfusion, respectively].…”

“…No guideline or recommendation is to date available for catecholamine choice/ dosage [15,23] as for intraoperative fluid amount and quality [24][25][26]. On the other hand, the excessive use of inotropes [27] and fluid infusions [9], as observed in our population, were both associated with adverse outcomes. A "goal-directed therapy," borrowed from critical care experience [28,29], may represent the optimal approach in this setting, although no studies are currently available in KTs [15].…”

“…Because no guideline defines the exact cut-off value in KTs, we set the hypotension threshold at 80 mmHg according to available experiences [4,9,10,15].…”

“…However, some reports suggest a higher risk of delayed graft function (DGF) secondary to a hypotension-mediated reduction in renal blood flow [9][10][11]. DGF, as well-known, negatively affects graft outcomes, including increased short-and long-term morbidity and mortality, allograft immunogenicity, acute rejection, hospitalization rates, and costs [1,[12][13][14].…”

Early Postoperative Use of Diuretics After Kidney Transplantation Showed Increase in Delayed Graft Function

“…19 Diuretic treatment was identified as predisposing factor in 33% of patients. Apart from rejection, typical etiologies of posttransplantation kidney injury are hemodynamic-mediated 20,21 or caused by ischemia-reperfusion damage. 22…”