Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Apr 18, 2021; 11(4): 114-128
Published online Apr 18, 2021. doi: 10.5500/wjt.v11.i4.114
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:
Corresponding author: Ramona Nicolau-Raducu, MD, PhD, Associate Professor, Department of Anesthesiology, University of Miami/Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33136, United States.
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
Research background

There is a profound need to increase the availability of deceased donor kidney transplantation (DDKT) to address the high incidence of kidney failure. However, 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.

Research motivation

Higher-risk kidney allografts more frequently exhibit delayed graft function (DGF), which has previously been associated with adverse outcomes such as acute rejection, chronic allograft nephropathy, shorter allograft survival, and increased costs. Furthermore, prior studies have pointed to an association between recipients’ blood pressure and the occurrence of DGF but have conflicted on the clinical setting and unique patient characteristics that may predispose to it.

Research objectives

A clear need exists for the identification and optimization of modifiable perioperative risk factors associated with DGF. We aim to identify risk factors associated with DGF, with a particular focus on perioperative hemodynamic factors, since these can be more readily optimized to improve graft and patient outcomes.

Research methods

Consecutive adults undergoing DDKT between January 2016 and July 2017 were identified with a study population of 294 patients. All donor data and recipients’ demographic, comorbidities, preoperative medications, and echocardiographic data within one year prior to transplant, as well as laboratory evaluation upon admission and intraoperative data were recorded. The primary outcome was the occurrence of DGF.

Research 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.

Research conclusions

We delineate the association between DGF and recipient characteristics of pre-induction MAP below 110 mmHg, metabolic syndrome, donor-specific risk factors, HMP pump parameters, and intraoperative use of phenylephrine.

Research perspectives

Future studies with larger multicenter cohorts are needed to further explore means to improve outcomes of recipients with suboptimal baseline or intraoperative blood pressure.