Background & Aim: Delayed graft function (DGF) generally refers to oliguria or the requirement for dialysis in the first week post-transplantation. It is the earliest and most frequent post- transplantation complication that can occur. DGF is an extremely important post- transplantation complication because its occurrence has short-term or long-term consequences for allograft survival. However, limited studies have been conducted on DGF and its complications in pediatric renal transplantation. Therefore, the aim of the present study was to determine short-term and long-term effects of DGF on allograft outcome in kidney transplanted children.Patients and Method: In this historical cohort study, 230 children who received kidney transplants between 1985 and 2005 in Labafi Nejad Hospital in Tehran were assessed through a mean follow-up period of 60.96(SD=40.46) months (ranging from 1 to 180 months). The children were divided into two groups: 183 children in group B (no DGF) as the control group and 47 patients in group A (DGF) as the case group. Risk factors of DGF and the impact of DGF on renal function within the first year, long-term graft survival, and post-transplantation complications were investigated and compared using Logistic regression model and Kaplan–Meier survival analysis.Results: The incidence of graft failure at the end of follow-up period was significantly higher in DGF group (53.2% vs. 22.4%, P<0.001). The mean graft survival length was 134.2(SEM=6.17) months in group B and 76.52(SEM=12.41) months in group A (P<0.001). The graft survival rate was 94.9%, 91.9%, 83.9%, 79.2% and 72% at 1, 3, 5, 7 and 12 years after transplantation in children without DGF versus 75.6%, 53.2%, 47.2%, 31.9% at 1, 3, 5 and 8 years after transplantation in patients with DGF. Dialysis before transplantation (P=0.039), acute rejection (P<0.001), immunosuppressive protocol without celcept (P<0.001) and the presence of DGF (P<0.001) were found as the significant risk factors for the occurrence of graft failure in the future.Conclusion: The results of our study showed that delayed graft function could remarkably and independently affect graft survival and worsen both short-term and long-term transplantation outcomes. This result is in contrast with the studies that only believe in the effect of DGF on short-term graft survival. However, in our study when patients whose grafts had failed during the first year after transplantation were censored, still significant differences were noted in graft survival between patients with and without DGF. Thus, the prevention of DGF is one of the most important issues in graft survival improvement.

Delayed graft function (DGF) is a transplant complication which means a need to dialysis throughout the first week after transplantation. This study aimed to ascertain the relationship between the two immunomodulatory factors of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble fibrinogen-like protein 2 (sFGL-2) with DGF after transplantation. This case-control study was done in 2 groups of 58 kidney transplant patients with and without DGF. The control group included the patients who didn’ t show DGF symptoms. Then, serum levels of sFlt-1and sFGL-2 in all blood samples were measured by ELISA. Serum sFlt-1 and sFGL-2 levels were significantly higher in the DGF group compared to those in the control group (p≤ 0. 001). sFlt-1 and sFGL-2 serum levels significantly affect DGF (p<0. 001) in such a way that they may be diagnostic factors of DGF. This study showed a significant relationship between sFlt-1 as well as sFGL-2 and DGF. Therefore, plasma levels of sFlt-1 and sFGL-2 may be used as diagnostic tools to determine the risk of DGF.

Introduction: Delayed graft function (DGF) is associated with significant adverse outcomes in deceased donor kidney transplantation (KT) including lower graft survival. However, risk factors and potential preventive strategies like intraoperative rabbit antithymocyte globulin (rATG; thymoglobulin) have not yet been fully evaluated. Objectives: The aim of this study was to investigate DGF risk factors and determine the association of intraoperative rATG with the risk of DGF in deceased donor kidney recipients. Patients and Methods: We retrospectively examined medical records of 163 first time deceased donor kidney transplant recipients at two major kidney transplant centers from 2014 to 2016. All the donors were standard heart-beating, brain death donors. Risk factors for DGF in recipients were evaluated using multivariate logistic regression analysis. Results: The mean recipients’ age was 43± 13 years and the majority of participants were male (64%). The overall rate of DGF was 27%. Intraoperative rATG was significantly associated with a lower rate of DGF (adjusted odds ratio [AOR], 0. 33, 95% CI, 0. 11-0. 95). Intraoperative transfusion (AOR, 3. 7, 95% CI, 1. 4-9. 9) and diabetes mellitus (AOR, 3. 7, 95% CI, 1. 5-8. 9) were significantly associated with higher risk of DGF. Conclusion: This study showed that intraoperative blood transfusion and diabetes mellitus were associated with increased risk of DGF. Meanwhile, administration of intraoperative rATG was associated with reduced odds ratio of DGF. Future studies are needed to evaluate the potential role of rATG in DGF-related renal outcomes.

Context: Delayed graft function (DGF) is an important clinical outcome following renal transplantation; therefore, it is important to be correctly diagnosed. The DGF is thought to correlate with the fi rst 24-hour urine output (UOP1), and this clinical sign is expected to predict DGF. Objectives: This study aimed to discover whether the UOP1 correlates signifi cantly to the DGF incidence and can be a DGF predicting factor. Data Sources: This study compared the incidence of DGF with the UOP1 reported by studies obtained from the electronic databases, namely MEDLINE, Cochrane, and EBSCO. Studies that performed multivariate or bivariate analysis and/or reported sensitivity and specifi city were included in this review. Results: A total of 1719 studies were obtained from the database search, and 2 studies were enrolled from other sources. Out of 1721 studies, 9 studies were recruited in this review, 5 of which reported sensitivity and specifi city. Overall, nine of these studies had a low to moderate risk of bias. Almost all studies reported a signifi cant relationship between the UOP1 and DGF. All studies agreed that the UOP1 is a sensitive predictive factor in predicting DGF. The specifi city reported by the studies examined in this review varied greatly. The use of optimum cut-off in each study is considered to be the cause of this variability. Conclusions: The UOP1 is signifi cantly related to the incidence of DGF and is a proper parameter for the prediction of DGF events.

Background: Delayed graft function (DGF) and acute rejection (AR) are common complications in kidney transplant patients. Objectives: The study evaluated DGF and AR in highly sensitized patients and their effects on kidney function for six months posttransplantation. Methods: We enrolled 95 patients with kidney transplants from living donors who were divided into two groups. Group 1 included 47 highly sensitized patients with panel reactive antibody (PRA) < 20. 0% and negative donor-specific antigen, and group 2 included 48 patients with negative PRA. All patients were followed for the state of DGF, AR, and kidney function for six months. Results: Group 1 showed a significantly higher proportion of DGF and AR than group 2 (27. 7% versus 2. 1%, P < 0. 001 and 14. 9% versus 2. 1%, P = 0. 031, respectively). The rates of positive PRA in DGF and AR patients were significantly higher than those in non-DGF and non-AR patients (92. 9% versus 42. 0%, P < 0. 001 and 87. 5% versus 46. 0%, P = 0. 031, respectively). Transplanted kidney function was significantly worse in patients with PRA and DGF and/or AR than in patients with negative PRA and non-DGF and non-AR only in the seventh-day post-transplantation. Conclusions: Kidney transplant in highly sensitized patients with positive PRA was related to the increased ratio of DGF and AR.

Purpose: Delayed graft function (DGF) is a form of acute renal failure which results in increased post-transplantation allograft immunogenicity and risk of rejection episodes in addition to decreased long-term survival. Its incidence and risk factors have been extensively studied, especially after deceased donation. However until now, only few data has been published on DGF in living donor kidney transplant recipients. The present study was performed to investigate the frequency and risk factors of DGF among living-kidney transplant recipients. Material and Methods: In this retrospective study, 500 living kidney transplant recipients recruited and data collected from hospital registries in three countries (Iran, Kingdom of Saudi Arabia (KSA), and Kuwait ). Results: Incidence of DGF revealed to be %95( %2. 3 CI: %3. 6-%0. 9). DGF group showed significant older age for the recipients and in “ without DGF” group, there were more females, and lower weight for the recipients. It was found that patients with DGF had longer pre transplant dialysis duration, cold ischemic and anastomosis time during surgery. Conclusion: DGF after living-donor kidney transplantation is a multifactorial complication which donor, recipient, and technical factors would lead toward. Consideration and optimization of these risk factors may drive through better long-term patient and graft outcomes in living kidney transplant recipients.

Introduction. Pulmonary hypertension (PHTN) is a common complication in patients with chronic kidney disease. Delayed Graft Function (DGF), on the other hand; is an essential complication after kidney transplantation. These two complications increase morbidity and mortality in patients. The effect of PHTN on cardiovascular and graft blood supply, as well as the same mechanisms underlying PTHN and DGF; led us to investigate the relationship between them. Methods. In this retrospective cohort study, 306 patients aged 18 years or older who underwent kidney transplantation at our center over a 4-year were enrolled. PTHN was diagnosed by transthoracic echocardiography performed by a cardiologist. DGF refers to the cases where the patient needs dialysis in the first week after kidney transplantation or if serum creatinine is ≥ 3 mg/dL on the 5th day after surgery. Results. The prevalence of PHTN was 43 (14. 1%), and the prevalence of DGF was 80 (26. 1%). PHTN was not correlated with age, sex, duration of dialysis, type of dialysis, and cause of renal failure. But DGF was associated with the duration and type of dialysis. DGF was found to be higher in patients undergoing hemodialysis (P <. 05), and patients with a higher mean duration of dialysis were also more likely to have DGF (P <. 05). Also, we concluded that there was a significant relationship between PHTN and DGF (P <. 05), meaning that patients with PTHN before transplantation were more likely to develop DFG. Conclusion. This study found that pre-transplant PTHN is an independent predictor of DGF in renal transplant patients.

Background: Delayed graft function (DGF) and slow graft function (SGF) are complications after kidney transplantation that resulted in poor short-term outcome. Objectives: In this study, we evaluate a new model for deceased kidney transplantation to reduce the cold ischemia time and its effect on DGF and SGF as short-term outcomes. Methods: Wehave included 814 deceased kidney transplanted patients in this study. All of the donors were local, while the recipients were both local and nonlocal. Kidney recipient’ s outcomes (included mortality rate as well as DGF and SGF), age, gender, BMI, blood group, Rh, allograft renal function, transplantation date, kidney transplantation history, PPD, positive history of rheumatologic disorders, the distance between home of recipient and the transplantation center, cardiovascular disease, and dialysis duration was evaluated for all patients. Results: The incidence of DGF and SGF were 24. 8% and 20. 5%, respectively. There were no statistical differences in the rate of DGF and SGF between local and distant recipients (P > 0. 21). The rate of DGF was significantly higher in females as well as 40-65 year old recipients (P < 0. 05). In logistic regression multivariate analysis, DGF and SGF were significantly correlated with BMI, blood group, the history of kidney transplantation, and dialysis duration. Conclusions: This study showed the feasibility of using a local donor for a distant recipient as well as reduction of cold ischemia time and lower rate of DGF. It is obvious that the shorter CIT, which resulted from usage of local donor, can lead to better kidney transplant outcomes.

Introduction: One of the frequent issues in deceased donor kidney transplantation is called Delayed graft function (DGF). There wasn’t a study reporting the prognostic predictive value of preoperative albumin to globulin ratio (AGR) and neutrophil to lymphocyte ratio (NLR) in DGF patients undergoing kidney transplantation. Hence, the primary objective of this prospective study is to evaluate the relation among preoperative AGR and NLR with a prognosis of DGF in patients who underwent renal transplantation.Methods: The outcome data were extracted including DGF occurrence, readmission, postoperative complications, and length of stay (LOS) at the hospital. We performed univariable and step-wise multivariable analysis to evaluate their impact on DGF and other mentioned outcomes. Collecting the recipients’ laboratory data before renal transplantation was performed.Results: The average (±SD) age of the 124 patients at renal transplantation was 42.85 (±14.39) years. AGR and NLR are not significantly related with the occurrence of DGF. TIBC (OR=0.981, P-value=0.038) was an independent negative prognostic factor for DGF occurrence. Age (RR=1.01, P-value<0.001), NLR (RR=1.186, P-value<0.001), Iron (RR=1.003, P-value=0.002) were independent positive risk factors for LOS, while increasing AGR (RR=0.713, P-value<0.001) and WBC (RR=0.954, P-value<0.001) were independent negative prognostic factors. WBC (OR=1.525, P-value=0.016) was an independent positive prognostic factor for readmission. Age (OR=1.12, P-value=0.009) and iron (OR=1.074, P-value=0.004) were independent positive prognostic factors for complication occurrence, and AGR (OR=0.0486, P-value=0.045) was a negative independent prognostic factor.Conclusion: AGR and NLR are not considerably related with the occurrence of DGF and readmission. NLR was a positive prognostic factor for LOS and AGR was a negative prognostic factor for occurrence of complications and increasing LOS. 

Introduction. Pre-transplant serum phosphorus level is shown to be associated with some transplant outcomes in patients with chronic kidney disease. However, its association with Delayed graft function (DGF) has an aura of ambiguity. DGF means either the patient needs dialysis during the first week after transplantation or the creatinine level is ≥ 3. This study was aimed to assess the relationship between pre-transplant serum phosphorus levels with DGF. Methods. A total of 306 patients, who had undergone kidney transplantation in the Montaserieh organ transplantation hospital in Mashhad, Iran, during 2016 to 2019; were enrolled in this study. Demographic data and clinical characteristics of patients including dialysis type and duration, donor type, medications, pre-transplant serum levels of calcium, phosphorus and DGF development were measured. Then, all patients were divided into five groups according to their serum phosphorus: P < 3. 5, 3. 5 ≤ P < 5. 5, 5. 5 ≤ P < 7. 5, 7. 5 ≤ P < 9. 5, and P ≥ 9. 5 mg/dL. The association with DGF was evaluated by statistical analysis. Results. Patients age ranged from 18. 00 to 64. 00 years old, with an average of 37. 08 ± 10. 9. About 55. 6% of them were men, and 26. 1% came up with DGF. Among patients with DGF, 36. 25% were recipients with pre-transplant phosphorus level of 3. 5 ≤ P < 5. 5 and 50% of 5. 5 ≤ P < 7. 5. Conclusion. Our study suggested that pre-transplant serum phosphorus might be associated with an increased risk of delayed graft function. Further studies are needed to assess, whether adjusting serum phosphorus level before kidney transplantation could reduce delayed graft function or not.