Delayed graft function influences renal function, but not survival

Background. In renal transplantation, the impact of delayed graft function (DGF) on prognosis is controversial. We analyzed the risk factors of DGF an d its impact on graft function and prognosis. Methods. Seven hundred thirty-four cadaveric renal transplants performed be tween 1983 and 1997 were analyzed. DGF was diagnosed when serum creatinine levels increased, remained unchanged, or decreased less than 10% per day in three consecutive days in the first week after transplantation. Creatinine clearances of more or less than 50 or 30 mL/min at one year were used as c ut-off points for optimal and suboptimal graft function, respectively. The logistic regression model was used to identify independent risk factor rela ted to DGF and renal function one year after transplantation. The Cox regre ssion model was used to examine the influence of DGF on longterm graft surv ival. Results. Multivariate analysis revealed the following risk factors for DGF: recipient pretransplantation mean arterial blood pressure of less than 100 mm Hg (OR = 2.08, 95% CI, 1.43 to 3.03), female donor to male recipient co mbination (OR = 1.55, 95% CI, 1.02 to 2.35), donor age of more than 50 year s (OR = 2.21, 95% CI, 1.49 to 3.26), cold ischemia time of re than 28 hours (OR = 1.78, 95% CI, 1.19 to 2.63), and peak panel reactive antibodies of m ore than 50% (OR = 1.7, 95% CI, 1.15 to 2.55). The incidence of DGF was one of the independent risk factors for suboptimal graft function at one year (OR = 1.68, 95% CI, 1.14 to 2.48), together with donor age of more than 50 years (OR = 2.39, 95% CI, 1.61 to 3.57), female donor gender (OR = 1.99, 95 % CI, 1.42 to 2.78), the occurrence of acute rejection episodes (OR = 2.66, 95% CT, 1.87 to 3.78), peak panel-reactive antibodies of more than 50% (OR = 1.67, 95% CT, 1.15 to 2.47), and sharing of 1 to 3 versus 4 to 8 crossre active antigens groups (OR = 1.65, 95% CI, 1.09 to 2.49). Moreover, DGF was one of the two independent risk factors for acute rejection episodes, but it had no independent effect on graft survival. Conclusion. Several risk factors for DGF were identified, of which a low re cipient pretransplant mean arterial blood pressure, the transplantation of kidneys from female donors to male recipients, and a prolonged cold ischemi a time are potentially avoidable. Although DGF is one of the several risk f actors of acute rejection and suboptimal function at one year, it is not in dependently associated with an increased rate of graft loss.