DELAYED GRAFT FUNCTION IN RENAL-TRANSPLANTATION - ETIOLOGY, MANAGEMENT AND LONG-TERM SIGNIFICANCE

Purpose: In cadaveric renal transplantation a period of delayed graft function postoperatively is not uncommon and often associated with a p oor outcome. We reviewed the biology of reperfusion injury and delayed graft function in renal transplantation, as well as its prevention, m anagement and long-term effects.Materials and Methods: The medical lit erature covering acute tubular necrosis, delayed graft function in ren al transplantation and immunology of ischemia reperfusion injury was r eviewed. Results: Delayed graft function is clearly associated with po or allograft survival, and is caused by an interaction of ischemic and immunological factors. Technical and pharmacological maneuvers can im prove early function rates. The response to ischemic injury is complex , and may increase graft immunogenicity and promote the chronic prolif erative changes seen in chronic allograft nephropathy. Conclusions: Im provement in early renal function should be a primary goal in renal tr ansplantation to enhance early and long-term results. Basic research i nto the injury response may yield insights into renal pathophysiology.