Abstract
Objectives: The aim of this study was: 1) To investigate if lactic dehydrogenase (LDH) levels is a marker for delayed graft function (DGF) and primary non-function (PNF) in kidney transplantation from non-controlled donors after cardiac death (DCD). 2) To evaluate the main risk factors of DGF and PNF in this population and their relationship with serum LDH levels. Materials and methods: All DCD kidney transplantation recipients from January 2008 to December 2011 were included (N=174, mean age 50.5±10 years, 68% male). We examined donor [age, creatinine levels, warm (WIT) and cold ischemic time (CIT)] and demographic recipient parameters, serum LDH and Tacrolimus levels post-transplant and ecographic and doppler data. We investigated the relationship between these parameters and incidence of acute rejection, DGF, PNF and parameters of renal function at one, three, six and twelve month post-transplant. For statistical analysis Student t, Kruskal-Wallis and Chi-square tests were used. Logistic regression analysis was used to determine independent risk factors for DGF and PNF. Results: All patients received induction therapy (Basiliximab or Thymoglobulin) and Tacrolimus as main immunosuppressive. Significant creatinine decrease took place at 16 (11-23) days. Maximum Tacrolimus and LDH levels were 14.7 (5.42) ng/mL and 2700 (1841-4016) UI/L, respectively. A statistical correlation between first day post-transplant LDH levels and CIT were found (r=0.186, p=0.031), but it did not happen in case of WIT (r=0.320, p=0.739). Logistic regression analysis revealed that LDH levels at first day post-transplant >3800 UI/L (percentile 75) (RR 7.911, 95% CI 2.104-29.750, p=0.002) and warm ischemic time (RR 0.966, 95% CI 0.934-0.999, p=0.044) were independent predictors of PNF. Maximum LDH levels>2600 UI/L (percentile 50) was predictor of DGF (RR 10.667, 95% CI 1.103-103.50, p=0.041). Tacrolimus levels>15 ng/mL (RR 2.319, 95% CI 0.926-5.860, p=0.073) and biopsy-proven acute rejection (BPAR) (RR 7.175, 95% CI 1.902-27.063, p=0.040) had a significant association with prolonged DGF (>16 days). Neither BPAR (MDRD-4=47.5±16.0 vs 49.5±18.0 mL/min, p=0.641) nor DGF (MDRD-4=47.1±16.1 vs 52.0±19.4 mL/min, p=0.167) had influence in first year renal function. However, significant differences were found in case of prolonged DGF (MDRD-4=45.5±14.5 vs 58.8±19.8 mL/min, p=0.033). Conclusion: Serum LDH levels in immediate post-transplant period could be a good marker for PNF and DGF in non-controlled DCD renal transplant recipients. WIT is the main risk factor of PNF in our study. These renal grafts have a special vulnerability to several injuries like high Tacrolimus levels and acute rejection episodes, which could impair the DGF. A prolonged DGF could have a negative impact in renal function at first year post-transplant.
Published Version
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