Effects of Ischemia and Reperfusion Injury on Long-Term Graft Function

Background. The clinical manifestation of ischemia/reperfusion injury in renal transplantation is delayed graft function (DGF), which is associated with an increase in acute rejection episodes (ARE), costs, and difficulties in immunosuppressive management. We sought to evaluated the DGF impact after renal transplant. Methods. We evaluated a group of 628 patients undergoing deceased donor renal transplantation between 2002 and 2005 at 3 Brazilians institutions to define the main DGF characteristics. Results. DGF incidence was 56.8%, being associated with elderly donors (P=.02), longer time on dialysis (P=.001), and greater cold ischemia time (CIT; P=.001). Upon multivariate analysis, time on dialysis >5 years increased DGF risk by 42% (P=.02) and CIT >24 hours increased it by 57% (P=.008). In contrast, DGF was associated with an higher incidence of ARE: 27.7% in DGF versus 18.4% in IGF patients (P=.047). The ARE risk was 46% higher among individuals with DGF (P=.02), 44% among patients >45 years old (P<.001), 50% among those with >5 years of dialysis time (P=.02), and 47% lower among the who were prescribed mycophenolate instead of azathioprine (P<.001). Patients with DGF showed worse 1-year graft function (54.6 +/- 20.3 vs 59.6 +/- 19.4 mL/min; P=.004), particularly those with ARE (55.5 +/- 19.3 vs 60.7 +/- 20.4; P=.009). One-year graft survival was 88.5% among DGF versus 94.0% among non-DGF patients. Conclusion. The high incidence of DGF was mainly associated with a prolonged CIT. There was a relationship between DGF and ARE, as well as with a negative influence on long-term graft function.