Posttransplantation acute tubular necrosis: Risk factors and implications for graft survival

Previous studies aimed at identifying the causes, risk factors, and outcome of kidney transplant recipients with delayed graft function (DGF) have yie lded controversial results. We retrospectively analyzed the causes and risk factors for DGF in 263 cadaveric kidney transplantations from November 198 8 to March 1997 in one center, Causes of DGF were assessed by postoperative graft evolution and graft biopsy, Univariate and multivariate analysis wer e used to investigate the risk factors for DGF induced by acute tubular nec rosis (ATN), Seventy-six patients (29%) had DGF, which was caused by ATN in 70 patients (92.1%) and acute rejection (AR) in 6 patients (7.9%), Therefo re, we focused on risk factors and consequences for ATN-induced DGF. In mon ofactorial analysis, ATN was significantly associated with greater weight a nd presence of an atheromatous disease in both donor and recipient. Other r isk factors for ATN were older age of donor, recipient American Society of Anesthesiology (ASA) physical status category IV, cold ischemia time (CIT), and transplantation using the right kidney. The multivariate analysis show ed that donor and recipient weight, donor age, transplantation using the ri ght kidney, preservation in Eurocollins solution, ASA score, and CIT were a ssociated with ATN, The incidence of rejection and renal function were not different at 3 months or 1 and 5 years. ATN is the main cause of DGF in kid ney transplant recipients. ATN is caused by donor and recipient vascular ba ckground, grafting the right kidney, and CIT. ATN does not appear to have a n adverse effect on long-term kidney function. (C) 1998 by the National Kid ney Foundation, Inc.