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- W2079587170 abstract "76 Delayed graft function (DGF) adversely affects long-term renal allograft survival and substantially increases the costs associated with transplantation. In a recent multivariate analysis, DGF increased length of stay by 5.6 days and charges by $16,853 at our institution. The purpose of this study was to: 1) clarify the importance of DGF as a risk factor for patient and graft survival following renal transplantation and 2) identify risk factors associated with DGF along with strategies to lessen its occurrence. METHODS: 430 consecutive cadaver renal transplants (excluding kidney/pancreas) performed over a 5-year period, beginning in 1993 were reviewed. A recipient database containing extensive demographic, immunological (including transplant number, PRA, HLA-matching, immunosuppressive protocol) and medical co-morbidity (such as presence of diabetes, coronary artery disease, congestive heart failure, prior CVA, COPD, hepatitis B or C) was linked to a cadaver donor database, which includes data such as donor demographics, renal function (admission and preharvest Cr), use of pressors, cold ischemia time and storage characteristics (cold vs. pump, renal resistance). DGF was defined as the need for dialysis within one week after transplantation. Univariate and multivariate statistical methods were used. RESULTS: DGF adversely affects not only graft, but patient survival. In multivariate analysis, DGF was the single most important variable (including use of induction antibody, tacrolimus and MMF) which correlated with graft survival and the second most important variable (behind recipient age), correlating with patient survival. Recipient risk factors associated with DGF (p<.05 for each) included: retransplants (Odds Ratio 2.8), pretransplant antibody titer ≥20% (OR 2.1), and body mass index >27 (BMI, OR 1.6). Co-morbid conditions such as diabetes, cardiac disease, COPD and others were not predictive of DGF. Significant donor factors included: black race (OR 2.5), age >55 yrs (OR 1.9), cold ischemic time > 18 hrs (OR 1.8), pump resistance (1.8) and BMI (OR 1.6). Using logistic regression to predict DGF, the following variables were independently significant in decreasing order of importance: retransplants, donor race, donor age, renal resistance and recipient BMI. Combinations of two or more risk factors yielded especially high rates of DGF. For example, kidneys from donors >55 yrs used for retransplants experienced DGF rates of 67% (compared to 26% incidence for primary transplants; p=.015). Kidneys from donors >55 yrs, transplanted into recipients with PRA >20%, experienced DGF 89% vs 25% for PRA <20% (p=.001). CONCLUSION: This study reaffirms the importance of DGF in the current era of renal transplantation, and suggests strategies for minimizing its occurrence. Organ procurement organizations and transplant centers may wish to avoid combinations of risk factors, which consistently lead to DGF in their organ allocation schemes." @default.
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- W2079587170 date "1999-05-01" @default.
- W2079587170 modified "2023-09-26" @default.
- W2079587170 title "ANALYSIS OF DONOR AND RECIPIENT RISK FACTORS FOR DELAYED GRAFT FUNCTION IN RENAL TRANSPLANTATION" @default.
- W2079587170 doi "https://doi.org/10.1097/00007890-199905150-00101" @default.
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