Copyright
©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Perioperative risk factors associated with delayed graft function following deceased donor kidney transplantation: A retrospective, single center study
Nicholas V Mendez, Yehuda Raveh, Joshua J Livingstone, Gaetano Ciancio, Giselle Guerra, George W Burke III, Vadim B Shatz, Fouad G Souki, Linda J Chen, Mahmoud Morsi, Jose M Figueiro, Tony M Ibrahim, Werviston L DeFaria, Ramona Nicolau-Raducu
Nicholas V Mendez, Yehuda Raveh, Joshua J Livingstone, Vadim B Shatz, Fouad G Souki, Ramona Nicolau-Raducu, Department of Anesthesiology, University of Miami/Jackson Memorial Hospital, Miami, FL 33136, United States
Gaetano Ciancio, George W Burke III, Linda J Chen, Mahmoud Morsi, Jose M Figueiro, Tony M Ibrahim, Werviston L DeFaria, Department of Surgery, Miami Transplant Institute/University of Miami/Jackson Memorial Hospital, Miami, FL 33136, United States
Giselle Guerra, Division of Nephrology of the Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL 33136, United States
Author contributions: Mendez NV designed research/study, wrote the paper; Raveh Y designed research/study, analyzed data, wrote the paper; Livingstone JJ designed research/study, wrote the paper; Souki FG, Shatz VB, Ciancio G, Burke III GW, Chen LJ, Morsi M, Figueiro JM, Ibrahim TM and DeFaria WL collected data; Guerra G collected data, analyzed data; Nicolau-Raducu R collected data, analyzed data, wrote the paper.
Institutional review board statement: The study was reviewed and approved by the University of Miami Institutional Review Board, No. 20170399.
Informed consent statement: The requirement for informed consent was waived by the institutional review board.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose and no competing financial interest.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ramona Nicolau-Raducu, MD, PhD, Associate Professor, Department of Anesthesiology, University of Miami/Jackson Memorial Hospital, 1611 NW 12
th Avenue, Miami, FL 33136, United States.
rxn256@miami.edu
Received: November 23, 2020
Peer-review started: November 23, 2020
First decision: January 25, 2021
Revised: February 5, 2021
Accepted: March 10, 2021
Article in press: March 10, 2021
Published online: April 18, 2021
Processing time: 135 Days and 14 Hours
BACKGROUND
There is an abundant need to increase the availability of deceased donor kidney transplantation (DDKT) to address the high incidence of kidney failure. Challenges exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients; thus the identification of modifiable risk factors associated with poor outcomes is paramount.
AIM
To identify risk factors associated with delayed graft function (DGF).
METHODS
Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 patients. The primary outcome was the occurrence of DGF.
RESULTS
The incidence of DGF was 27%. Under logistic regression, eight independent risk factors for DGF were identified including recipient body mass index ≥ 30 kg/m2, baseline mean arterial pressure < 110 mmHg, intraoperative phenylephrine administration, cold storage time ≥ 16 h, donation after cardiac death, donor history of coronary artery disease, donor terminal creatinine ≥ 1.9 mg/dL, and a hypothermic machine perfusion (HMP) pump resistance ≥ 0.23 mmHg/mL/min.
CONCLUSION
We delineate the association between DGF and recipient characteristics of pre-induction mean arterial pressure below 110 mmHg, metabolic syndrome, donor-specific risk factors, HMP pump parameters, and intraoperative use of phenylephrine.
Core Tip: There is an abundant need to increase the availability of deceased donor kidney transplantation to address the high incidence of kidney failure. Challenges exist in the utilization of higher risk donor organs into what appears to be increasingly complex recipients; thus the identification of modifiable risk factors associated with poor outcomes is paramount. We delineate the association between delayed graft function and recipient characteristics of pre-induction mean arterial pressure below 110 mmHg, metabolic syndrome, donor-specific risk factors, hypothermic machine perfusion pump parameters, and intraoperative use of phenylephrine.
