Transpl Int. 2008;21:126-132
Increasing duration of dialysis is associated with an increased risk of delayed graft function (DGF) following renal transplantation, researchers in Canada have found.
Douglas S. Keith, MD, and his colleagues at McGill University Health Center in Montreal studied data on 30,294 patients who received deceased-donor renal allografts between January 2000 and December 2003. They used two definitions of DGF: the need for dialysis in the first week following transplantation (DPT) and a creatinine decline of less than 25% in the first 24 hours after transplant (slow graft function [SGF]).
The rate of DPT and SGF was 5.7% and 33.4%, respectively, for patients who received pre-emptive transplants; it was 32% and 49.9% for patients who had been on dialysis for six or more years. The adjusted risk of DPT and SGF was 6.6 times and 1.76 times greater in patients for patients on dialysis for six or more years compared with patients who underwent pre-emptive transplantation.
The study is the first to examine the dialysis status of renal transplant recipients and the duration of dialysis as a risk factor for DGF, the authors stated.
“Delayed graft function is both detrimental to recipient outcomes post-transplant and cost to the healthcare system as a whole,” the researchers wrote. “Efforts to limit this complication have, for the most part, concentrated on decreasing cold ischemia time and improving donor management prior to organ procurement. This study suggests that potentially modifiable recipient factors exist that may be as important as cold ischemia time in the incidence of DGF.”
They explained that their findings are “consistent with the hypothesis that the compensatory changes associated with advanced chronic renal failure may actually promote early graft function in the transplant setting.”