Delayed graft function (DGF) after living donor kidney transplantation: a study of possible explanatory factors

Delayed graft function (DGF), caused by failure of the kidney to function properly after transplantation, has a lower incidence rate in living donor transplantation compared to deceased donor transplantation. The aim of this study was to investigate the possible risk factors related to DGF in living donor transplantations.

A prospective, observational cohort study of patients undergoing living donor renal transplantation was designed. The incidence of DGF was investigated; the urine levels of neutrophil gelatinase-associated lipocalin (NGAL) and interleukin 18 (IL-18) were measured on the 1st and 3rd day after transplantation, and the relationships of DGF incidence and potential explanatory factors were studied.

DGF was observed in 16.2% of patients. Preliminary univariate analyses showed that older donors, retransplantation, previous blood transfusion, and low urinary output could be eligible predictors for DGF. Analysis of the urinary biomarkers revealed an association between DGF incidence with the level of NGAL on the 1st day after transplantation, level of IL 18 on the 3rd post-operative day, and with the differences in urine NGAL levels measured in 2 samplings. Multivariate logistic regression analysis showed that only the differences between the 1st and 3rd days of urinary NGAL levels could remain in the final model.

Although, possibly due to living donor transplantation, none of the patient/donor characteristics could act as an explanatory factor for DGF; however, special attention is still required to target post-operation inflammation and oxidative stress, confirmed by relationship observed between DGF and urine NGAL levels on postoperative days.