Study On Delayed Graft Function In Transplant Recipients

In 1960's ,kidney transplantation was developed to treatendstage renal disease .From then on ,delayed graft function (DGF)had been a difficulty to overcome.Many studies had been done aboutthe course of DGF and the influence on survival of kidneytransplantation recipients,but there was no satisfaction .DGF is acommon complication and a sort of acute renal failure after kidneytransplantation, caused by immune or non-immunal factors. Thereare more rejection episodes and infection in DGF, which exercise agreat influence on survival rate of graft and recipient and increaseexpense-time in hospital. In order to improve the long-term survivalof renal allografts ,efforts should focus on improving ourunderstanding and better treatments of DGF.DGF is defined as that hemodialysis is necessary in the firstweek after kidney transplant or serum creatinine level is over400umol/l. DGF is one severe complication after renal transplanta-tion, the incidence of which is 20% or so .Many factors can cause DGF, which include pre-renal , renaland post-renal factors . Low blood volume , hypotension, renalarteries stenosis , arterial thrombosis are pre-renal factors. Thereare some renal factors such as acute tubular necrosis , early acuterejection episodes , acceleration rejection or acute rejection episodes ,medicine poison and so on. Urinary obstruction is the mainpost-renal factor.Many scholars have an agreement on the importance ofhistocompatibility:matchment type of Histocompatibility leukocyteantigen (HLA) can directly identify the donor-recipient's compatib-ility ,and greatly increase the long-term survival rate of graft.DGF can be diagnosed by clinical symbols such as anuria,continuous high serum creatinine level or slow decrease andnecessary hemodialysis. It is difficult to identify the correct cause ofDGF , which has a negative effect on the long-term survival of renalallograft. Recently , experienced doctor can find the cause of DGFaccording to symptom , sign , experimental outcome , dopullaultrasonic and biopsy.There is a significant relation between DGF which mainlyoccur anuria and recover time of allogrft function . The shorter thetime of anuria ,the better recovery of allograft , otherwise , therewould be many complications such as infection , heart failure andeven to death. Effective treatment of DGF , immunosuppressionmedications and decrease the incidence of complications havesignificant impact on the short-term and long-term survival rate ofrenal allograft. Once DGF occurs, a complicated healing plan shouldbe made . For example ,we should take preventive measures onacute rejection related graft crack , on acute heart failure and onsystematic infection .Because of DGF's importance influence on short-term andlong-term survival of renal transplantation allograft / recipient ,scholars should take effective efforts on lower occurrence of DGFand higher quality of renal allograft . They'd better choose theagreeable donor and recipient , the precise type of histomatchment ,the suitable donor graft preserve and perfusion , surgical efforts onshorter cold or warm ischaemia time, maintaining the stability ofperi-operation , proper immunosuppression medications and so on .In order to investigate the cause and treatment of DGF afterkidney transplantation , we retrospectively reviewed the records of97 renal allograft recipients with DGF. Between January 2000 andDecember 2005,623 renal transplantations were performed inZhong-ri friendly hospital. Of all the recipients , 32(32/623, 5.1%)cases dead in early post-transplant (within 3 months),23 patients(23/623,3.7%)received nephrectomy caused by no function of earlyallograft, and 568 recipients (568/623,91.2%) acquired early graftfunction. 268 patients (268/623,44.9﹪)whose serum creatininelevel decreased to 200umol/l or even lower within 7 days gainedimmediate graft function(IGF). Serum creatinine level decreasedbelow 200umol/l after 7 days and urine volume was over 2000ml perday and patients need not hemodialysis in slow graft function(SGF,n=203,203/623,32.6%). Delayed graft function (DGF ,n=97,97/623,15.6%)patients whose renal function hadn't recovered andwhose urine volume < 1000ml per day need hemodialysis.TheDGF's pathogenesis include acute rejection(AR,n=45),acute tubularnecrosis ( ATN,n=39) , iliac venous thrombosis (n=3), ureteralobstruction(n=3),cyclocytidine A poison(n=7).RESULTS : 76patients of DGF recovered normal function after transplantation , 19recipients of DGF 's serum creatinine level was 200umol/l or so ,one case dead in infection after using antilymphocyteglobulin(ALG) , one patient need hemodialysis with failure toMethylprednisolone(MP) treatment . CONCLUTIONS : AR is majorfactor of DGF after kidney transplantation , and panel reactiveantibodies (PRA) and HLA mismatch are risk factors of DGF . ALGhas been performed to resist acute rejection, DGF without AR has noimpact on one-year survival of patient and graft, whereas , recipientsof DGF with AR has a lower one-year survival.In summary ,with the deep study of DGF, improving donorgraft preserve ,surgical development , shorter cold or warmischaemia time, better stability of peri-operation and properimmunosuppression medications , the incidence of DGF will bedecreased ,furthermore the life quality and survival time of renalallografts /recipients will be increased.