Elsevier

The Lancet

Volume 364, Issue 9447, 13–19 November 2004, Pages 1814-1827
The Lancet

Review
Delayed graft function in kidney transplantation

https://doi.org/10.1016/S0140-6736(04)17406-0Get rights and content

Summary

Delayed graft function is a form of acute renal failure resulting in post-transplantation oliguria, increased allograft immunogenicity and risk of acute rejection episodes, and decreased long-term survival. Factors related to the donor and prerenal, renal, or postrenal transplant factors related to the recipient can contribute to this condition. From experimental studies, we have learnt that both ischaemia and reinstitution of blood flow in ischaemically damaged kidneys after hypothermic preservation activate a complex sequence of events that sustain renal injury and play a pivotal part in the development of delayed graft function.

Elucidation of the pathophysiology of renal ischaemia and reperfusion injury has contributed to the development of strategies to decrease the rate of delayed graft function, focusing on donor management, organ procurement and preservation techniques, recipient fluid management, and pharmacological agents (vasodilators, antioxidants, anti-inflammatory agents). Several new drugs show promise in animal studies in preventing or ameliorating ischaemia-reperfusion injury and possibly delayed graft function, but definitive clinical trials are lacking. The goal of monotherapy for the prevention or treatment of is perhaps unattainable, and multidrug approaches or single drug targeting multiple signals will be the next step to reduce post-transplantation injury and delayed graft function.

Section snippets

Definition

One barrier to study of delayed graft function and thus to comparison of results from clinical trials is substantial ambiguity as to its current definition. Early renal function ranges from total anuria or non-oliguric acute tubular necrosis (ATN), to slow recovery of function, to rapid and immediate function. Nevertheless, the terms delayed graft function and ATN are often used to define the same disorder, though the former is a clinical diagnosis and the latter is a histopathological or

Conclusion

Delayed graft function remains common in cadaveric renal transplantation, and is important because it increases risk of early or late graft loss. During the past few years, our understanding of the mechanisms mediating ischaemia-reperfusion injury in the general setting, and more specifically in kidney transplantation, has improved greatly. Systematic screening of genes that are upregulated or downregulated during ischaemia-reperfusion damage has further indicated the complexity of factors and

Search strategy and selection criteria

We searched MEDLINE from 1966 to 2004, using the following key words: delayed graft function, ischemic (and ischaemic) injury, reperfusion injury, kidney transplantation, graft outcome, and acute rejection. We also searched the bibliographies of articles for relevant references. Because of the large number of articles identified and limitations for quoting references, the decision on what to include was a personal judgment.

Conflict of interest statement

We declare that we have no conflict

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