Delayed Graft Function in Kidney Transplants: Time Evolution, Role of Acute Rejection, Risk Factors, and Impact on Patient and Graft Outcome

Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From...

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Bibliographic Details
Published in:Journal of Transplantation 2015-01, Vol.2015 (2015), p.14-22
Main Authors: Le Moine, Alain, Abramowicz, Daniel, Vereerstraeten, Pierre, Mikhalsky, Dimitri, Hougardy, Jean-Michel, Baudoux, Thomas, Massart, Annick, El Mountahi, Fadoua, Broeders, Nilufer, Racapé, Judith, Chaumont, Martin, Hamade, Anwar
Format: Article
Language:English
Subjects:
Graft rejection
Kidneys
Patient outcomes
Physiological aspects
Risk factors
Transplantation
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Summary:Background. Although numerous risk factors for delayed graft function (DGF) have been identified, the role of ischemia-reperfusion injury and acute rejection episodes (ARE) occurring during the DGF period is ill-defined and DGF impact on patient and graft outcome remains controversial. Methods. From 1983 to 2014, 1784 kidney-only transplantations from deceased donors were studied. Classical risk factors for DGF along with two novel ones, recipient’s perioperative saline loading and residual diuresis, were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results. Along with other risk factors, absence of perioperative saline loading increases acute rejection incidence (OR = 1.9 [1.2–2.9]). Moreover, we observed two novel risk factors for DGF: patient’s residual diuresis ≤500 mL/d (OR = 2.3 [1.6–3.5]) and absence of perioperative saline loading (OR = 3.3 [2.0–5.4]). Area under the curve of the ROC curve (0.77 [0.74–0.81]) shows an excellent discriminant power of our model, irrespective of rejection. DGF does not influence patient survival (P=0.54). However, graft survival is decreased only when rejection was associated with DGF (P
ISSN:2090-0007
2090-0015
DOI:10.1155/2015/163757