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MeSH Review

Delayed Graft Function

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Disease relevance of Delayed Graft Function

  • Clinicians need to decide the best means of optimising therapy for individual patients, based on various risk factors, such as risk of rejection, i.e. sensitisation, delayed graft function and ABO-incompatibility, and some adverse events, such as hypertension, hyperlipidaemia and cosmetic changes [1].
  • Cyclosporine did not increase the incidence of delayed graft function, compared with ALG-azathioprine-treated patients (33% versus 27%, P = 0.550) but doubled the mean (+/- SD) duration of oliguria (11.8 +/- 11.0 versus 5.9 +/- 3.2 days, P = 0.002) and the number of required dialyses (6.6 +/- 7.6 versus 3.2 +/- 1.3, P = 0.031) [2].
  • Factors potentially affecting graft outcome, such as sex, donor and recipient's age, HLA A-B match, cold ischaemia time (CIT), delayed graft function (DGF), serum creatinine at 1 month (Cr1), rejection episodes within 3 months (R3), and type of brain death (BD), were considered [3].
  • The aetiology of delayed graft function (DGF) is multifactorial, and factors including donor management, technique used for organ procurement and preservation, age, anatomical variations in the graft, ischemia periods, use of cyclosporine A (CyA) or recipient immunological reactions have been implicated [4].
  • In addition, in transplanted kidneys, ICAM-1 inhibition by antisense ODN ameliorates ischemia-reperfusion injury and prevents delayed graft function [5].

High impact information on Delayed Graft Function


Chemical compound and disease context of Delayed Graft Function


Biological context of Delayed Graft Function


Gene context of Delayed Graft Function

  • Genetic determination of TNF-alpha and IL-10 production was associated with delayed graft function and rejection [20].
  • The expression of ICAM-1 molecules on tubular cells was determined to be a predictor for the occurrence of delayed graft function in cadaveric kidneys (ICAM-1: 65+/-24* vs. 38+/-29% delayed graft versus primary graft function) [21].
  • Delayed graft function does not influence long-term outcome in cadaver kidney transplants without mismatch for HLA-DRB1 [22].
  • HYPOTHESIS: Calcineurin-sparing protocols using anti-IL-2 receptor (IL-2R) antibody induction (Simulect) may benefit initial kidney function in these patients, as assessed by the rates of delayed graft function and of rejection during the first month after transplant [23].
  • There was no significant difference in incidence of delayed graft function in recipients with a low MBL level (< or =400 ng/mL) compared to those with a higher MBL level (>400 ng/mL) (37.1 vs. 34.9%) [24].

Analytical, diagnostic and therapeutic context of Delayed Graft Function


  1. Calcineurin inhibitors in renal transplantation: what is the best option? Tanabe, K. Drugs (2003) [Pubmed]
  2. The effects of delayed function on recipients of cadaver renal allografts. A study of 158 patients randomized to cyclosporine or ALG-azathioprine. Canafax, D.M., Torres, A., Fryd, D.S., Heil, J.E., Strand, M.H., Ascher, N.L., Payne, W.D., Sutherland, D.E., Simmons, R.L., Najarian, J.S. Transplantation (1986) [Pubmed]
  3. An objective method for detecting time-dependent effects in graft survival. Boschiero, L., Foroni, R., Tonini, M., Ancona, G. Transpl. Int. (2000) [Pubmed]
  4. A preliminary report of the HTK randomized multicenter study comparing kidney graft preservation with HTK and EuroCollins solutions. HTK Study Group. Groenewoud, A.F., Thorogood, J. Transpl. Int. (1992) [Pubmed]
  5. Diapedesis of leukocytes: antisense oligonucleotides for rescue. Dragun, D., Haller, H. Exp. Nephrol. (1999) [Pubmed]
  6. Prevention of delayed graft function in cadaver kidney transplants by diltiazem. Wagner, K., Neumayer, H.H. Lancet (1985) [Pubmed]
  7. Factors associated with improvement in deceased donor renal allograft function in the 1990s. Keith, D.S., DeMattos, A., Golconda, M., Prather, J., Cantarovich, M., Paraskevas, S., Tchervenkov, J., Norman, D.J. J. Am. Soc. Nephrol. (2005) [Pubmed]
  8. Addition of sirolimus to cyclosporine delays the recovery from delayed graft function but does not affect 1-year graft function. Stallone, G., Di Paolo, S., Schena, A., Infante, B., Battaglia, M., Ditonno, P., Gesualdo, L., Grandaliano, G., Schena, F.P. J. Am. Soc. Nephrol. (2004) [Pubmed]
  9. The absence of delayed graft function is predicted by the presence of manganese-superoxide dismutase in distal tubules of renal allografts. Boom, H., de Heer, E., van der Wal, A., Kruidenier, L., de Fijter, J.W., Benediktsson, H., Paul, L.C., van Es, L.A. Transplantation (2005) [Pubmed]
  10. HSP-72 expression in pre-transplant donor kidney biopsies and post-transplant outcome. Mueller, T., Regele, H., Posch, M., Marszalek, M., Schwarz, C., Pichlhoefer, B., Arbeiter, K., Aufricht, C. Transplantation (2004) [Pubmed]
  11. Time dependency of factors affecting renal allograft survival. Prommool, S., Jhangri, G.S., Cockfield, S.M., Halloran, P.F. J. Am. Soc. Nephrol. (2000) [Pubmed]
  12. Continued superior outcomes with modification and lengthened follow-up of a steroid-avoidance pilot with extended daclizumab induction in pediatric renal transplantation. Sarwal, M.M., Vidhun, J.R., Alexander, S.R., Satterwhite, T., Millan, M., Salvatierra, O. Transplantation (2003) [Pubmed]
  13. A calcineurin antagonist-free induction strategy for immunosuppression in cadaveric kidney transplant recipients at risk for delayed graft function. Hong, J.C., Kahan, B.D. Transplantation (2001) [Pubmed]
  14. Clinical outcomes during the first three months posttransplant in renal allograft recipients managed by C2 monitoring of cyclosporine microemulsion. Thervet, E., Pfeffer, P., Scolari, M.P., Toselli, L., Pallardó, L.M., Chadban, S., Pilmore, H., Connolly, J., Buchler, M., Schena, F.P., Carreño, C.A., Dandavino, R., Cole, E. Transplantation (2003) [Pubmed]
  15. Improved results using OKT3 as induction immunosuppression in renal allograft recipients with delayed graft function. Benvenisty, A.I., Cohen, D., Stegall, M.D., Hardy, M.A. Transplantation (1990) [Pubmed]
  16. Effect of cyclosporine and delayed graft function on posttransplantation erythropoiesis. Besarab, A., Caro, J., Jarrell, B., Burke, J., Francos, G., Mallon, E., Karsch, R. Transplantation (1985) [Pubmed]
  17. Pharmacokinetics of mycophenolic acid in renal transplant patients with delayed graft function. Shaw, L.M., Mick, R., Nowak, I., Korecka, M., Brayman, K.L. Journal of clinical pharmacology. (1998) [Pubmed]
  18. Effective renal plasma flow calculated from a single blood sample following Technetium-99m mercaptoacetyltriglycine renal scan can predict delayed graft function in renal transplantation. Freedland, S.J., Mishkin, F., Shoskes, D.A. Techniques in urology. (2001) [Pubmed]
  19. IP-10, apoptotic genes, and calcineurin subtype messenger RNA kinetics occurring in rat renal isografts from brain-dead donors. Kusaka, M., Fukami, N., Sasaki, H., Higuchi, T., Ishikawa, K., Shiroki, R., Hoshinaga, K. Transplant. Proc. (2005) [Pubmed]
  20. Effect of cytokines and chemokines (TGF-beta, TNF-alpha, IL-6, IL-10, MCP-1, RANTES) gene polymorphisms in kidney recipients on posttransplantation outcome: influence of donor-recipient match. Lacha, J., Hribova, P., Kotsch, K., Brabcova, I., Bartosova, K., Volk, H.D., Vitko, S. Transplant. Proc. (2005) [Pubmed]
  21. The contribution of adhesion molecule expression in donor kidney biopsies to early allograft dysfunction. Schwarz, C., Regele, H., Steininger, R., Hansmann, C., Mayer, G., Oberbauer, R. Transplantation (2001) [Pubmed]
  22. Delayed graft function does not influence long-term outcome in cadaver kidney transplants without mismatch for HLA-DRB1. Ichikawa, Y., Hashimoto, M., Hanafusa, T., Kyo, M., Fujimoto, N., Matsuura, O., Takahara, S., Hayashi, R., Ihara, H., Ono, Y. Transpl. Int. (1995) [Pubmed]
  23. Calcineurin-free protocols with basiliximab induction allow patients included in "old to old" programs achieve standard kidney transplant function. Emparan, C., Laukötter, M., Wolters, H., Dame, C., Heidenreich, S., Senninger, N. Transplant. Proc. (2003) [Pubmed]
  24. Association between mannose-binding lectin levels and graft survival in kidney transplantation. Berger, S.P., Roos, A., Mallat, M.J., Fujita, T., de Fijter, J.W., Daha, M.R. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. (2005) [Pubmed]
  25. A comparison of the effects of cyclosporine versus antilymphocyte globulin on delayed graft function in cadaver renal transplant recipients. Michael, H.J., Francos, G.C., Burke, J.F., Besarab, A., Moritz, M., Gillum, D., Jarrell, B. Transplantation (1989) [Pubmed]
  26. Mycophenolate mofetil reduces the risk of acute rejection less in African-American than in Caucasian kidney recipients. Schweitzer, E.J., Yoon, S., Fink, J., Wiland, A., Anderson, L., Kuo, P.C., Lim, J.W., Johnson, L.B., Farney, A.C., Weir, M.R., Bartlett, S.T. Transplantation (1998) [Pubmed]
  27. Use of anti-CD25 monoclonal antibody in combination with rapamycin to eliminate cyclosporine treatment during the induction phase of immunosuppression. Hong, J.C., Kahan, B.D. Transplantation (1999) [Pubmed]
  28. Individualization of immediate posttransplant immunosuppression. The value of antilymphocyte globulin in patients with delayed graft function. Matas, A.J., Tellis, V.A., Quinn, T.A., Glicklich, D., Soberman, R., Veith, F.J. Transplantation (1988) [Pubmed]
  29. Prostaglandin E1 reduces the risk of delayed graft function after cadaveric renal transplantation. Hollenbeck, M., Dinter, K., Torsello, G., Koch, M., Willers, R., Sandmann, W., Grabensee, B. Nephrol. Dial. Transplant. (1999) [Pubmed]
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