Factors Impacting Delayed Graft Function from Uncontrolled Donors after Circulatory Deathy


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Abstract

IntroductionDelayed graft function(DGF) is a frequent complication in recipients of renal transplant (RTR) from uncontrolled donors after donation after circulatory deathy (uDCD), requiring elective biopsy to rule out rejection and significantly increasing length of hospital stay.ObjectivesTo investigate the factors associated with DGF in RTR from uDCD.MethodsWe studied 640 RTR from uDCD at our institution since 1996, excluding those without primary function. We collected the following time points: cardiac arrest, cardiopulmonary resuscitation, extracorporeal circulation and cold ischemia. The use of perfusion machine, type of perfusion (normovs hypothermia), causes of death of the donor, demographic parameters of donor and recipient, immunosuppressive treatment and acute rejection were also studied. We performed univariate and multivariate statistical analyses.ResultsThe incidence of DGF, defined as the need for dialysis in the first week, was 65%. The incidence of non-improvement in renal function on the first day post-transplant was 93.3%. The median time to improved graft function was 17 days (IQR 11-22 days). Univariate and logistic multivariate analyses to predict a DGF longer than 11 days (P25 of the sample), disclosed that female RTR (OR 1.49, 95% CI 1.01-2.19), diabetes (OR 2.79, 95% CI 1.33-5.85), previous transplant (OR 1.81, 95% CI 0.96-3.44), cold ischemia time in hours (HR 1.06, IC95% 1.00-1.12) and duration of previous dialysis in years (HR 1.03, IC95% 1.02-1.04) were significantly associated with DGF.ConclusionThe only factor amenable to modification that may prevent DGF in RTR from uDCD is cold ischemia. Therefore, every effort should be made to shorten duration of cold ischemia in this type of transplants as much as possible.

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