Risk Factors Of Delayed Graft Function Of Kidney Transplantation From Donation After Citizen's Death

Objective: To summarize the occurrence of delayed graft function(DGF)of kidney transplantation from donation after citizen's death,to analyze the risk factors for DGF after kidney transplantation.Methods : Clinical date of 369 cases with kidney transplantation from donation after citizen's death from Jan.2015 to Dec.2016 was conducted.The perioperative clinical data of all 369 patients who had undergone kidney transplantation were analysed retrospectively.According to whether or not DGF developed post transplantation,369 patients were divided into DGF group and Immediate Graft Function(IGF)group.Major clinical variables included donor age,donor kidney from the left or right,donor type,preoperative serum creatinine of donors,the cause of brain death,Cold Ischemia Time(CIT),Warm Ischemia Time(WIT),recipient age,the preoperative dialysis time of recipient,Panel Reactive Antibodies(PRA),Human Leukocyte Antigen(HLA).Several statistically significant risk factors were screened out with univariate analysis,then independent risk factors were determined with multivariate stepwise logistic regression analysis.Results: DGF occurred in 52 of 369 kidneys from donation after citizen's death,the morbidity of DGF was 14.09%.Univariate analysis showed that the occurrence of DGF was associated with Donation after Cardiac Death(DCD)and Donation after Brain plus Cardiac Death(DBCD)(P<0.001),preoperative serum creatinine of donors ? 177umol/L(P<0.001),cold ischemia time ? 10h(P=0.004)and warm ischemia time ? 4min(P<0.001).On multivariate analysis,DCD and DBCD,preoperative serum creatinine of donors ?177umol/L,cold ischemia time ? 10 h,warm ischemia time ? 4min were independent risk factors for the development of DGF.And we obtained fresh kidney tissues from the patients occurrence DGF for HE staining to observe the change of kidney tissues.The pathological changes of DGF are mainly renal tubular necrosis,epithelial cell loss,distal tubule and collecting duct,and the infiltration of lymphocytes.Conclusions: The occurrence of DGF is influenced by many factors,including donor factors,receptor factors and immune factors.In this study,DCD and DBCD,preoperative serum creatinine(177umol/L),CIT > 10 h,WIT > 4min were independent influencing factors of DGF.Therefore,the incidence of DGF could be reduced by removing those influencing factors and timely organ donation,prognosis of the recipients after kidney transplantation could be improved.