Predictive Factors Associated with Delayed Graft Function Following Renal Transplantation: A Retrospective Cohort Study

Abstract

Kidney transplantation has become a routine procedure for end-stage renal disease. Although improvement in short term graft patency has been achieved, delayed graft function (DGF) is one of the important complications following kidney transplantation. DGF results from ischemia-reperfusion injury and involves a multitude of contributing elements including donor characteristics and etiology of the end-stage renal disease. The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are easily applicable methods for evaluation of systemic inflammation. We hypothesized that these parameters could refine the detection of the patients with DGF in post- renal transplantation and guide management. To test our hypothesis, we investigated whether the NLR, PLR, and creatinine reduction ratio CRR could serve as prognostic indicators for identifying patient cohorts at an elevated risk of negative treatment outcomes following renal transplantation. We also assessed demographic and clinical factors as an independent predictor to detect negative early graft function outcomes in patients after renal transplantation. This single center retrospective cohort trial comprising 55 patients who received a kidney graft from deceased or living donors was performed in Northern Cyprus Ministry of Health’s Dr. Burhan Nalbantoglu State Hospital, over a 6 year period. The demographic and clinical variables included age, gender, body mass index, the etiology of end-stage renal disease, kidney graft from living or deceased donors, NLR, PLR and CRR. DGF was defined as GFR<60 on the 21th day following renal transplantation. Of the patients included in this study, 26 (47.3%) and 29 (52.7%) received deceased and living donor kidney transplantation, respectively. On the 21st day following transplantation, 27 patients (49%) had an eGFR<60, whereas 28 patients (51%) had an GFR≥60. None of the patients had undergone dialysis within the first week after transplantation. There were no significant differences in demographic and clinical characteristics between the patients with eGFR 60 and eGFR 60. In logistic regression analysis, none of the predictors including etiology of the end-stage renal disease, source of donor, or demographic baseline characteristic were associated with DGF. We suggest that the NLR and PLR parameters are not associated with the presence of DGF after renal transplantation. Keywords: Renal transplantation, Delayed graft function, Renal failure, Glomerular filtration rate, End-stage renal disease.