RESUMEN
INTRODUCTION: Delayed renal graft function (DGF) is associated with various factors and with a higher complication rate in the posttransplant period. Determination of center-specific risk factors may help to reduce the incidence of DGF and improve transplantation results. The aim of this study was to define risk factors for the development of DGF after renal transplantation. PATIENTS AND METHODS: This study included 290 consecutive deceased donor renal transplantations performed in a single center between January 1, 2004, and November 30, 2007. All cases were examined for the presence of DGF, defined as the need for at least 1 dialysis during the first posttransplant week. The subjects were divided into 2 groups: immediate graft function and DGF. Both groups were compared for donor and recipient transplantation factors as well as early posttransplant results. RESULTS: DGF was observed in 61 cases (21%). Our analysis revealed associations of DGF with recipient age (P = .011), female gender (P = .028), donor age (P = .033), body mass index (P = .007), severe hemodynamic disturbances (P = .005) preexistent glomerular or interstitial sclerosis (P = .002 or P = .028, respectively); and cold ischemia time (CIT; P = .019). Trends toward significance were observed with recipient weight > 100 kg (P = .078), and diabetes mellitus (P = .109). Recipients who experienced DGF showed on higher rate of acute rejection, a longer hospital stay, and an higher level serum creatinine at discharge (P < .001 for all). CONCLUSION: DGF had deleterious effects in the early posttransplant period. Careful allocation and reduction of CIT may improve transplantation results.
Asunto(s)
Cadáver , Trasplante de Riñón/patología , Daño por Reperfusión/epidemiología , Donantes de Tejidos , Adulto , Factores de Edad , Anciano , Peso Corporal , Complicaciones de la Diabetes/epidemiología , Femenino , Hemodinámica , Humanos , Pruebas de Función Renal , Trasplante de Riñón/fisiología , Masculino , Persona de Mediana Edad , Terapia de Reemplazo Renal , Estudios Retrospectivos , Factores de Riesgo , Caracteres SexualesRESUMEN
INTRODUCTION: The vascular condition influences the outcomes of arteriovenous fistula (AVF) surgery. However, it has not been established how it influences the outcomes of renal transplantation and the development of chronic allograft nephropathy (CAN). The aim of this study was to define the relationship between AVF failure in the pretransplant period and the development of CAN. PATIENTS AND METHODS: In this study we included all patients who underwent AVF surgery and then first kidney allotransplantations from January 1, 1999 to December 31, 2002. Patients were divided into two groups according to the AVF surgery outcomes: group 1 (n = 45, mean age 50 +/- 13 years, male/female ratio 27/18) had no vascular access complications and were dialysed through a native AVF. Group 2 (n = 39, mean age 51 +/- 11 years, male/female ratio 17/22) had additional interventions due to AVF failure. We analyzed the incidence of CAN in both groups. RESULTS: During the follow-up period CAN was observed in five patients in group 1 and 11 patients in group 2 (11,1% vs 28,2%, P < .05). There was a statistically significant relationship between CAN and acute rejection episodes (P < .005) and diabetes mellitus (P < .05). CONCLUSION: Failures of arteriovenous fistulas in hemodialysis patients were associated with an increased incidence of CAN in the posttransplant period.