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The role of donor and recipient factors in initial renal graft non-function
L S Belli1, L De Carlis, E Del Favero
1Department of Surgery, Niguarda CaGranda Hospital, Milan, Italy.
Abstract:
ATN is a deleterious problem in the outcome of kidney transplantation. This complication is usually related to multiple factors including donor parameters, surgical technique, ischemic time, and recipient variables. In order to develop prophylactic measures, out of 430 kidney transplants performed in our Department, a series of 90 consecutive cadaveric renal allografts has been considered in this study. The overall incidence of IGNF was 23/90 (25.5%). Kidneys from MOD revealed a lower rate of IGNF (7/35 = 20%) when compared with organs from SOD (16/55 = 29%, P = NS). No difference was noted when kidneys were removed together with heart and/or liver and/or pancreas. Out of the donor factors, only CID was significant (17 +/- 9 hours in IGNF v 11 +/- 10 hours in patients with IGF, P = less than .05). Analysis of data concerning the fate of paired kidneys revealed two cases of IGNF in both kidneys from the same donor v 14 cases of IGNF in only one of the two paired grafts (P = NS). We conclude that: 1. Donor factors are clearly associated with a minority of IGNF. 2. The introduction of multiorgan procurement programs does not complicate early function. 3. Recipient factors (immunological events and intraoperative fluid management) provides important additive effects on initial graft nonfunction.
Insights
Delayed graft function after kidney transplantation is common. Donor factors like cold ischemia time influence this, but recipient factors play a significant role in early graft nonfunction.
Area of Science:
- Nephrology
- Transplantation Immunology
- Surgical Outcomes
Background:
- Early graft nonfunction (EGNF) is a significant complication in kidney transplantation.
- Multiple factors contribute to EGNF, including donor characteristics, surgical techniques, ischemia duration, and recipient variables.
- Understanding these factors is crucial for developing prophylactic strategies.
Purpose of the Study:
- To investigate the incidence and contributing factors of early graft nonfunction in cadaveric renal allografts.
- To evaluate the impact of donor type and procurement methods on EGNF.
- To identify specific donor and recipient variables associated with EGNF.
Main Methods:
- Retrospective analysis of 90 consecutive cadaveric renal allografts from 430 kidney transplants.
- Comparison of EGNF rates between kidneys from multiple organ donors (MOD) and single organ donors (SOD).
- Analysis of donor factors, including cold ischemia time (CID), and recipient variables.
Main Results:
- The overall incidence of EGNF was 25.5% (23/90).
- Kidneys from MOD showed a trend towards lower EGNF (20%) compared to SOD (29%), though not statistically significant.
- Cold ischemia time was significantly longer in grafts experiencing EGNF (17 hours vs. 11 hours, P < .05).
- Recipient factors, such as immunological events and fluid management, significantly contributed to EGNF.
Conclusions:
- Donor factors are associated with a subset of EGNF cases.
- Multiorgan procurement programs do not appear to increase the risk of EGNF.
- Recipient-related factors exert a substantial influence on initial graft nonfunction, highlighting areas for intervention.