Effects Of Donor And Recipient Perioperative Factors On Delayed Graft Function

Objective: To investigate the related risk factors of delayed graft function(DGF)after renal transplantation by analyzing the clinical data of donors and recipients of kidney transplantation,so as to provide a reference for improving the prognosis of transplanted kidney function.Methods: Patients with end-stage renal disease undergoing allogeneic kidney transplantation at the Affiliated Hospital of Zunyi Medical University from January 2017 to April 2020 were divided into the DGF group and the immediate graft function(IGF)group.The information of donors and recipients,including clinical data,laboratory examination data,tissue matching,cold and warm ischemic time,perioperative management factors and so on,were collected.The risk factors of DGF were analyzed by single factor and multifactor logistic regression.Results: A total of 104 kidney transplant patients were included,average age was 39(39.30±10.52)years,the ratio of male to emale was 1: 0.65,dialysis age was 17(6-36)months,the eighty two percent recipients received hemodialysis,4 patients(3.85%)had no history of dialysis.The eighty percent of recipients was chronic glomerulonephritis,blood type match was 89 cases,7 patients(6.73%)panel reactive antibody(PRA)were positive,and complement dependent cytotoxicity(CDC)was negative in all cases.There were 23 cases of DGF(22.12%)and 81 cases of IGF(77.88%).In the basic conditions of the two groups,the recipient's body mass index(BMI)(P=0.027),the kidney donor with acute kidney injury(AKI)(P= 0.002),donors' creatinine level(P=0.022)before donation,the dose of norepinephrine(NE)used within 24 hours before donor passed away(P=0.040),cold ischemic time(CIT)(P=0.014),warm ischemia time(WIT)(P=0.016)and the induction drug(mycophenolate,rabbit anti-human thymocyte immunoglobulin)(P=0.017)were significantly different between the two groups.The DGF group was significantly higher than that of the IGF group.Regression analysis showed that the immune-inducing drugs(mycophenolate mofetil,rabbit anti-human thymocyte immunoglobulin)(P=0.041),donors with AKI(P=0.004),and high dose of norepinephrine(NE)used within 24 hours before donor passed away(P=0.010),high donors' creatinine level(P=0.036)before donation,high recipients' BMI(P=0.030),prolonged CIT(P=0.011),prolonged WIT(P=0.014)were risk factors for DGF,and prolonged CIT(P=0.003),prolonged WIT(P=0.022),immune induction drugs(P=0.023)were independent risk factors for DGF.Conclusion: Many factors during perioperative donors and recipients management contribute to the occurrence of DGF after kidney transplantation,among which prolonged period of cold and warm ischemia,and the use of immune induction drugs are independent risk factors for DGF.