Introduction: Hyperglycemia is common and a contributing factor to the undesirable outcomes in kidney transplant recipients. This study investigates the relationship of pretransplant blood glucose levels and the occurrence of delayed graft function among kidney transplant recipients without a diagnosis diabetes mellitus before transplantation.Materials and Methods: Eighty-one patients on long-term hemodialysis with no history of clinically diagnosed diabetes mellitus were enrolled in this study. Correlation of the occurrence of delayed graft function with age, gender, donor source, underlying cause of kidney failure, insulin resistance, and blood glucose levels before transplantation was evaluated.Results: There was a significant correlation between abnormal glucose metabolism categories and occurrence of delayed graft function (P=.004). Logistic regression analysis showed that fasting blood glucose before kidney transplantation is an independent predictor of delayed graft function immediately after transplantation (odds ratio=1.042, P=.04).Conclusions: Hyperglycemic patients have an increased risk for delayed graft function and should be treated by more potent immune therapy and further restriction of blood glucose regulation in peritransplantation period.

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.

Background: Delayed graft function (DGF) remains as an important complication in renal transplantation with obvious short-term and possible long-term disadvantages.Objective: To determine the influence of recipient and donor factors on the development of delayed graft factors and their impact on the long-term graft survival.Methods: A total of 237 living kidney recipients were reviewed with regards to recipients and donors’ factors. Delayed graft function was defined as a need for dialysis during the first week after transplantation or failure of serum creatinine to decrease below pretransplant levels within one week regardless of urine out put. Effect of patients’ factors on the development of delayed graft function and its effect on I and 5 years graft survival were studied.Results: Thirty-six out of 237 patient's experienced delayed graft function (15.2%). Incidence of delayed graft function was 10.6% in recipients of living related donors compared to 24.4% in living unrelated donors (p=0.002). One and 5 years graft survival were 85.5% and 69.5% in patients with immediate graft function and 81.0% and 57.9% in patients with delayed graft function respectively.Conclusion: The only risk factor for delayed graft function in recipients of living kidney transplant as shown by this study was living unrelated kidney donation. Delayed graft function seems to have no deleterious effect on 1 and 5 years graft survival.

Introduction: The role of serum neutrophil gelatinase-associated lipocalin (NGAL) in predicting delayed graft function (DGF) after kidney transplantation is poorly defined. The objective of this study was to evaluate the serum NGAL expression in the early postoperative phase after kidney transplantation and compare it with serum creatinine (Cr). Methods: We studied 29 patients who received kidney transplantation from deceased (n=24) and lived (n=5) donors from October 2017 to December 2018 at the Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Serum NGAL, Serum Cr, and urine output were measured at 1 to 7 days after transplantation. The need for dialysis in one week after transplantation was evaluated. Results: Among 29 recipients with serum biomarkers measurements, 8 (27. 5%) developed DGF (need to hemodialysis within one week of transplantation). Resulted in areas under ROC curves (AUCs) for serum NGAL at early hours following transplantation was (0. 839, 95% CI: 0. 69-0. 98, p-value=0. 005) that could accurately predict DGF compared to urine output (0. 747, 95% CI: 0. 55-0. 93, p-value=0. 045) and serum Cr (0. 607, 95% CI: 0. 34-0. 86, p-value=0. 398) at 24 hours after transplantation. Multivariate analysis revealed that only serum NGAL was a significant independent predictor of DGF (OR: 0. 996, 95% CI: 0. 993-1. 000, p-value=0. 039). Conclusions: Serum NGAL at early hours of post-transplantation was a valuable biomarker for an early accurate predictor of DGF in kidney transplantation compared with traditional biomarkers such as serum Cr and urine output.

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.

Introduction. Kidney transplantation is the best and final solution for ESRD children. Many countries have programs for extending and improving the transplanted centers. Owing to the fact that we need to improve our transplanted centers, we evaluated the frequency of delayed and slow graft function (DGF and SGF, respectively), its etiologies, and the final short-term outcome of kidney transplanted children in a new established center in Isfahan, Iran.Methods. The data of 24 kidney-transplanted children under 18 years were collected between February 2002 and September 2008,. A phone call was made for each patient to reconfirm demographic data. Results. Thirteen patients (54.2%) were male and 11 (45.8%) were female. The mean age was 14.16 ± 2.72 years. FSGS was the most frequent cause of ESRD followed by renal hypodysplasia and SLE. Mean duration of dialysis before transplantation was 19.95 ± 18.82 months. Eighteen kidneys (75%) were extracted from living donors (mostly unrelated) and 25% from cadavers. About 45% of the patients experienced some degrees of delayed graft function mostly due to ATN followed by acute humoral rejection. Five of them had slow graft function (starting kidney function in less than 7 days) and 4 patients had delayed graft function. Three patients had no graft function leading to nephrectomy. Only one of the nephrectomized kidneys was donated to a girl with SLE from cadaver and the etiology of DGF was renal vein thrombosis. Two kidneys were nephrectomized due to technical problems. Kidney function of all patients with DGF or SGF improved in a mean time of 3.66 ± 1.1 days. The final glomerular filtration rate of these patients was 88.54 ± 6.83ml/min/m². Conclusion. Assessment of kidney transplanted patients is a main part of evaluating transplanted centers. It seems that a further revision of transplantation protocol and fluid therapy during surgery should be done.