Delayed graft function

Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet 2004 364 1814-1827. 

Delayed graft function In patients with delayed graft function posttransplant, mean MPA AUC was comparable, but MPAG AUC was 2- to 3-fold higher, compared to that seen in posttransplant patients without delayed graft function. No dose adjustment is recommended for these patients however, they should be carefully observed. 

E. Therapeutic response The safety and efficacy of Simulect, when added to a standard immunosuppressive regimen comprised of cyclosporine and corticosteroids, were assessed in two placebo-controlled trials. The primary end point in both studies was the incidence of death, graft loss, or an episode of acute rejection during the first 6 months post-transplantation. Patients receiving Simulect experienced a significantly lower incidence of biopsy-confirmed rejection episodes at both 6 and 12 months after transplantation, but there was no difference in the rate of delayed graft function, patient survival, or graft survival between Simulect-treated patients and placebo-treated patients in either study. 

A recent study of high-risk renal transplants compared Thymoglobulin induction with Simulect. The overall risk of rejection, delayed graft function and graft loss was statistically less frequent with Thymoglobulin . (Brennan, DC. A prospective, randomized, multi-center study of thymoglobulin compared to simulect for induction immunosuppression preliminary results. 2002 American Transplant Congress.)... 

Goncalves LF, Ribeiro AR, Berdichevski R, Joelsons G. 2007. Basiliximab improves graft survival in renal transplant recipients with delayed graft function. Transplant Proc. 39 437 138. 

Sandrini S. Use of IL-2 receptor antagonists to reduce delayed graft function following renal transplantation a review. Clin Transplant. 2005 19 705-710. 

Increase in TAC is not always a good prognostic it may simply indicate an initial response to oxidative stress, as with concentrations of individual antioxidants and activities of antioxidant enzymes, or when it is due to disturbances in uric acid metabolism. Because uric acid is the main determinant of TAC of blood plasma, TAC increases in situations when the concentration of urate is increased, for example, in metabolic disorders and kidney failure. TAC is increased in urine from renal transplant recipients with delayed graft function (SI6). Ischemia of small intestine leads to an increase in TAC of rat blood serum, which is maximal (almost twofold) immediately after termination of 45-min ischemia (S22). TAC of blood plasma of rats poisoned with a high dose of carbon tetrachloride (1200 mg/kg, intraperitoneal injection, measurement 16 hr after injection) was significantly (over twofold) increased (Kl). These apparently paradoxical effects can be explained, however, by release of antioxidants from cells undergoing necrosis. Increase in TAC after intensive physical exercise also may be a marker of tissue... 

Parikh CR, Jani A, Mishra J, Ma Q, Kelly C, Barasch J, Edelstein CL, Devarajan P. Urine NGAL and IL-18 are predictive biomarkers for delayed graft function following kidney transplantation. Am J Transplant 2006 7 1639-1645. 

There are four potential clinical presentations for acute CSA nephrotoxicity asymptomatic increases in serum creatinine (SCr) without overt renal dysfunction, acute kidney injury, delayed graft function after renal transplantation and recurrent or de novo hemolytic uremic syndrome (Table 2). 

Craved P, Codreanu , Satta A, Turturro M, Sghirlanzoni M, Remuzzi G, Ruggenenti P. Cyclosporine prolongs delayed graft function in kidney transplantation are rabbit anti-human thymocyte globulins the answer Nephron Clin Pract 2005 101 c65-71. 

McTaggart RA, Gottlieb D, Brooks J, Bacchetti P, Roberts JP, Tomlanovich S, Feng S. Sirolimus prolongs recovery from delayed graft function after cadaveric renal transplantation. Am J Transplant 2003 3 416-423. 

CCNU lomustine DGFR delayed graft function recovery... 

Calcium chaimel blockers traditionally have been the first-line agents to treat hypertension after transplantation. In addition to their ability to control blood pressure, calcium channel blockers may ameliorate the nephrotoxic effects of CSA, improve renal hemodynamics, decrease the incidence of delayed graft function and development of allograft atherosclerosis, and provide some immunosuppression. Calcium channel blockers, however, also may contribute to gingival hyperplasia that is often associated with CSA-based immunosuppression. CYP 3A4 interactions with CSA and TAC are of concern with this class of medications, particularly with dil-tiazem, verapamil, and nicardipine, and CSA or TAC concentrations must be monitored to ensure proper dosage adjustments. 

Delayed recovery of post-transplant renal allograft dysfunction was seen more often in the past when elevated doses of cyclosporine were used, principally with the concomitant occurrence of prolonged ischemic times. This event has been largely diminished by the delay of onset of CsA administration until good renal graft function is present or by the use of alternative schedules for induction of immunosuppression that spare calcineurin blockers [2, 3]. Withdrawal of CsA in renal transplant patients with delayed graft function has been associated with less severe and shorter renal dysfunction [274]. 

Smith KD, Wrenshall LE, Nicosia RF, Pichler R, Marsh CL, Alpers CE, Polissar N, Davis CL. Delayed graft function and cast nephropathy associated with tacrolimus plus tapamycin use. J Am Soc Nephrol (2003) 14, 1037 5. 

Shoskes, D. A. and Halloran, P. F. (1996) Delayed graft function in renal transplantation etiology, management and long-term significance. J. Urology 155,1831-1840. 

Vilalta R, Lara E, Madrid A, Chocron S, Vazquez A, Casquero A, Nieto J. Delayed graft function is reduced with antithymocyte globulin induction in pediatric kidney transplantation. Transplant Proc 2009 41 (6) 2373-5. 

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