Impact of delayed graft function on renal function and graft survival in deceased kidney transplantation

Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Hong Kong.
Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine (Impact Factor: 0.87). 10/2010; 16(5):378-82.
Source: PubMed


To define the risk factors for delayed graft function and study the impact of such delays on renal function and long-term allograft survival in renal transplant recipients.
Single-centre retrospective study.
Regional hospital, Hong Kong.
Records of 118 Chinese renal transplant recipients from 1 July 1997 to 31 July 2005 were reviewed, and categorised into delayed and immediate graft function groups.
Delayed graft function was observed in about 19% of patients, for which cold ischaemic time was an important independent predictor. For each additional hour of cold ischaemic time, the odds ratio increased for delayed function by 0.002 (95% confidence interval, 0.001-0.003; P=0.03). Multivariate analysis revealed that neither cold ischaemic time nor delayed graft function was associated with acute rejection. On the other hand, at 1 year both delayed graft function (odds ratio=18.5; 95% confidence interval, 2.6-130.5; P=0.003) and donor age (1.2; 1.1-1.3; P=0.003) were related to a glomerular filtration rate of less than 30 mL/min. When renal function between patients with and without delayed graft function during the first 3 years was compared, it was significantly better in those without delayed graft function. However, there was no significant difference in death-censored graft survival between delayed graft function and immediate graft function groups.
Delayed graft function has a significant adverse effect on graft function at 1 year. Limiting cold ischaemic time is important as it is an independent predictor of delayed graft function.

Download full-text


Available from: Chi Yuen Cheung, Oct 13, 2015
66 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the immunosuppressant cyclosporine (CsA) is widely used after kidney transplantation over the long term, there is still no firm consensus on the best way to monitor of CsA blood levels. Cyclosporine (CsA) assay is critical for the management of renal transplant recipients due to inter- and intra-patient variation in CsA absorption and metabolism. In a retrospective cross sectional study, blood levels of CsA (through and 2 hours post dose) measured at least 5 times during 3 years post transplantation, in 7702 kidney transplant recipients from different transplant center of Tehran, IR Iran between 2008 and 2012. Cyclosporine absorption (CA) calculated C2/C0 ratio. CA had a significant correlation with allograft function (P = 0.000, r =.0.285), this correlation was stronger than its relationship with C0 and C2 blood levels (P = 0.000 and P = 0.000 as well as r = 0.033 and r = 0.090, respectively). In univariate analysis during different times after transplantation, C0 and C2 blood levels significantly decreased over three years follow up (P = 0.000), (P = 0.000); While, CA reversely increases over the time (P = 0.000). In linear regression model overall CA levels had correlation with lower age of recipient (P = 0.02), hypokalemia (P = 0.001), higher level of creatinine (P = 0.02) and triglyceride (P = 0.001). The present study shows that CsA absorption changes trough the post-transplant time and appears to increases over time in long-term period after kidney transplantation.
    03/2012; 4(2):470-4. DOI:10.5812/numonthly.2437
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Acute renal graft rejection episodes have a major impact on long term renal allograft survival. There has been a reduction in the incidence of acute rejection in the past three decades due to usage of potent immunosuppressive drugs. Objectives: To measure the incidence of acute renal allograft rejection among Egyptian renal transplant recipients, to identify their risk factors and their impact on graft and patient survival. Methods: Combined retrospective and prospective study was done on kidney transplant recipients in Nasr City Health Insurance Hospital center, Cairo Egypt, whom received kidney transplantation in the period from 2000 up to 2005. Data extraction sheet was designed to collect data retrospectively from records during the period (2000-2005) and follow up of patients was done for the period (2005-2013). Diagnosis of acute rejection was done by clinical and laboratory data, administration of anti-rejection treatment and by biopsy when available. Results: Seventy four living donor recipients were included in the study. Twenty four received kidneys from related donors and fifty from unrelated donors. We encountered 16 (21.6%) patients with acute rejection episodes. Of them 15 (93.75%) acute T cell mediated rejection and one (6.25%) Acute Antibody-Mediated Rejection and 37.5% of them occurred within the first 6 months post transplantation. Complete recovery of normal graft function occurred in five cases (31.25%), while 11 cases (68.75%) remained with mild renal impairment. No significant difference between related and unrelated donor regarding incidence of acute rejection. Five patients developed graft loss and one case of death recorded due to cardiac disease. Twelve years graft survival rate was (93.2%) with median survival time 11 years using Kaplan Meier method. Conclusion: The incidence of acute rejection episodes still high among Egyptian renal transplant recipients in single center. Optimization of immunosuppression and facilitating usage of induction therapy in high risk patients is recommended. [Yasser Soliman, Sahar Shawky, Abd-Elrahman Khedr, Azza M. Hassanand Maha Behairy. Incidence of Acute Renal Allograft Rejection in Egyptian Renal Transplant Recipients: A Single Center Experience. Life Sci J 2015;12(3):9-15]. (ISSN:1097-8135). 3
    Life Science Journal 01/2015; 12(3):9-15. · 0.17 Impact Factor