Delayed Graft Function After Renal Transplantation

Overview

Journal Open Med (Wars)

Specialty General Medicine

Date 2025 Feb 17

PMID 39958975

Authors

Darijus Skaudickas

Povilas Lenciauskas

Augustas Skaudickas

Andrejus Bura

Affiliations

Soon will be listed here.

Abstract

Background Information: Delayed graft function (DGF), defined as the need for dialysis within the first week of a kidney transplant, is a common complication, particularly in extended criteria donor transplants, where its incidence ranges from 21 to 31%.

Objectives: We observed a prolonged case of DGF in a 47-year-old patient with chronic kidney disease (CKD) resulting from diabetic nephropathy. The patient, classified in a moderate immunologic mismatch group, received a marginal deceased donor kidney.

Results: For the first 4 weeks post-transplantation, graft function was impaired. After 29 days of anuria, the transplanted kidney began to recover. The literature review found few clinical cases of DGF extending beyond 1 month. Our patient had several risk factors for DGF, including diabetes mellitus, pre-transplant hemodialysis, and moderate immunologic mismatch. Additionally, the marginal graft increased the risk of ischemia-reperfusion injury and glycocalyx damage. However, it remains unclear how these factors influenced the duration of DGF. The exact cause of the extended DGF in this case remains unknown. Although the literature identifies key risk factors for DGF, data on factors leading to prolonged kidney dysfunction are lacking. Therefore, decisions to remove a non-functioning transplanted kidney should not be made hastily.

References

Bahl D, Haddad Z, Datoo A, Qazi Y . Delayed graft function in kidney transplantation. Curr Opin Organ Transplant. 2018; 24(1):82-86. DOI: 10.1097/MOT.0000000000000604. View

Phillips B, Ibrahim M, Greenhall G, Mumford L, Dorling A, Callaghan C . Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study. Am J Transplant. 2021; 21(10):3346-3355. DOI: 10.1111/ajt.16574. View

Basile D, Friedrich J, Spahic J, Knipe N, Mang H, Leonard E . Impaired endothelial proliferation and mesenchymal transition contribute to vascular rarefaction following acute kidney injury. Am J Physiol Renal Physiol. 2010; 300(3):F721-33. PMC: 3064142. DOI: 10.1152/ajprenal.00546.2010. View

Ghoneima A, Sousa Da Silva R, Gosteli M, Barlow A, Kron P . Outcomes of Kidney Perfusion Techniques in Transplantation from Deceased Donors: A Systematic Review and Meta-Analysis. J Clin Med. 2023; 12(12). PMC: 10298857. DOI: 10.3390/jcm12123871. View

Parekh J, Bostrom A, Feng S . Diabetes mellitus: a risk factor for delayed graft function after deceased donor kidney transplantation. Am J Transplant. 2010; 10(2):298-303. DOI: 10.1111/j.1600-6143.2009.02936.x. View

Joachim E, Gardezi A, Chan M, Shin J, Astor B, Waheed S . Association of Pre-Transplant Dialysis Modality and Post-Transplant Outcomes: A Meta-Analysis. Perit Dial Int. 2016; 37(3):259-265. DOI: 10.3747/pdi.2016.00011. View

Ali H, Mohammed M, Fulop T, Malik S . Outcomes of thymoglobulin versus basiliximab induction therapies in living donor kidney transplant recipients with mild to moderate immunological risk - a retrospective analysis of UNOS database. Ann Med. 2023; 55(1):2215536. PMC: 10228322. DOI: 10.1080/07853890.2023.2215536. View

Argaiz E, Rola P, Haycock K, Verbrugge F . Fluid management in acute kidney injury: from evaluating fluid responsiveness towards assessment of fluid tolerance. Eur Heart J Acute Cardiovasc Care. 2022; 11(10):786-793. DOI: 10.1093/ehjacc/zuac104. View

Kelly Wu W, Famure O, Li Y, Kim S . Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int. 2015; 88(4):851-8. DOI: 10.1038/ki.2015.190. View

10.

Schulz T, Pries A, Kapischke M . Delayed Graft Function 5 Months After Living Donor Kidney Transplantation. Am J Case Rep. 2016; 17:120-3. PMC: 4771100. DOI: 10.12659/ajcr.895806. View

11.

Siedlecki A, Irish W, Brennan D . Delayed graft function in the kidney transplant. Am J Transplant. 2011; 11(11):2279-96. PMC: 3280444. DOI: 10.1111/j.1600-6143.2011.03754.x. View

12.

Budhiraja P, Reddy K, Butterfield R, Jadlowiec C, Moss A, Khamash H . Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation. BMC Nephrol. 2022; 23(1):154. PMC: 9017045. DOI: 10.1186/s12882-022-02777-9. View

13.

Peng P, Ding Z, He Y, Zhang J, Wang X, Yang Z . Hypothermic Machine Perfusion Versus Static Cold Storage in Deceased Donor Kidney Transplantation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Artif Organs. 2018; 43(5):478-489. DOI: 10.1111/aor.13364. View

14.

Leao-Reis F, de Carvalho Silva B, de Morais J, Santos J, Dias-Sanches M . Delayed Graft Function Duration in Deceased Donor Kidney Transplants. Transplant Proc. 2022; 54(5):1247-1252. DOI: 10.1016/j.transproceed.2022.02.062. View

15.

Nieuwenhuijs-Moeke G, Pischke S, Berger S, Sanders J, Pol R, Struys M . Ischemia and Reperfusion Injury in Kidney Transplantation: Relevant Mechanisms in Injury and Repair. J Clin Med. 2020; 9(1). PMC: 7019324. DOI: 10.3390/jcm9010253. View

16.

Salvadori M, Rosso G, Bertoni E . Update on ischemia-reperfusion injury in kidney transplantation: Pathogenesis and treatment. World J Transplant. 2015; 5(2):52-67. PMC: 4478600. DOI: 10.5500/wjt.v5.i2.52. View

17.

Lopez-Hoyos M, Fernandez-Fresnedo G, Rodrigo E, Ruiz J, Arias M . Effect of delayed graft function in hypersensitized kidney transplant recipients. Hum Immunol. 2005; 66(4):371-7. DOI: 10.1016/j.humimm.2005.01.026. View

18.

Smudla A, Trimmel D, Szabo G, Fazakas J . Systolic Blood Pressure Pattern: The Tick Mark Signal of Delayed Renal Graft Function. Transplant Proc. 2019; 51(4):1226-1230. DOI: 10.1016/j.transproceed.2019.03.010. View

19.

Cruz P, Cabral Dias Filho A, Santana V, Boaretto R, Riccetto C . Donor Age Amplifies the Detrimental Effects of Cold Ischemia Time on Long-Term Kidney Allograft Survival Independently of the Occurrence of Delayed Graft Function or Early Acute Rejection. Exp Clin Transplant. 2020; 18(4):436-443. DOI: 10.6002/ect.2020.0066. View

20.

Martins P, Buchwald J, Mergental H, Vargas L, Quintini C . The role of normothermic machine perfusion in liver transplantation. Int J Surg. 2020; 82S:52-60. DOI: 10.1016/j.ijsu.2020.05.026. View