Predictors for delayed graft function in living donor kidney transplantation
T.M. Huijink, G.J. Nieuwenhuijs-Moeke, N. Sajadjan, R.A. Pol, S.P. Berger
Chair(s): dr. A. Nurmohamed
Thursday 9 march 2017
12:45 - 13:00h
Categories: Poster - Klinisch
Parallel session: Postersessie - Klinisch 2
Living donor kidney transplantation has experienced a marked increase in the Netherlands and despite the excellent results a risk of complications remains. Delayed graft function (DGF) is an uncommon complication after living donor kidney transplantation with a reported incidence of 5%. However, as DGF after living donor transplantation is unexpected, it has a major impact on post-operative care, resulting in numerous diagnostic procedures including early biopsies. The aim of this study was to evaluate possible predictive perioperative factors for developing DGF after living donor kidney transplantation.
All living donor kidney transplantations performed between 1993 and 2013 were extracted from our transplant database and analyzed. For each identified subject with DGF, three matched controls with similar recipient characteristics (gender, age and year of transplantation) were then included to form the control group. DGF was defined as the need for dialysis within the first week after transplantation. Recipient and donor characteristics (i.a. body mass index, preoperative dialysis, gender and HLA mismatches and ABO incompatibility) were evaluated in addition to various surgical and anesthesia parameters (i.a. right or left kidney, number of arteries and veins, ischemia times, duration of hypotension and anaesthetic and analgesic agents).
From a total of 690 living donor transplant patients, 4,1% developed DGF. Predominantly males were transplanted (62.2%), with a mean age of 49.0±12.9 years (mean ± SD). Only pre-transplantation dialysis (OR 3,069; 1,270-7,417; p=0.013) and transplantation of the right kidney (OR 3,786; 1,627-8,811; p=0.002) were predictors for the development of DGF after living donor kidney transplantation. Anesthetic management seemed to be of no influence during this period. Ischemia times and duration of hypotension did not correlate with the occurrence of DGF.
The finding that pre-transplantation dialysis is a risk factor for DGF after living donor kidney transplantation may be related to recipient volume status. Careful assessment of volume status and correction of hypovolemia prior to transplantation may be helpful in the prevention of DGF after living donor kidney transplantation. Our finding of the importance of the use of the right kidney requires further evaluation, but if confirmed, may be taken into consideration in kidney side selection.
