Prevention of Poor Early Graft Function Using Open Nephrectomy, and Minimizing the Risk of Procedure-Related Factors

ABSTRACT

Purpose: To determine the incidence of immediate graft function (IGF), identify events causing delayed graft function (DGF), slow graft function (SGF), and factors that promoted IGF in our living donor transplant recipients using kidneys recovered exclusively by open donor nephrectomy (ODN).

Methods: We performed a recipient- and donor-database analysis after approval from our institutional review board.

Results: Out of 211 recipients, IGF was established in 99.2%, a prolonged recipient warm ischemia time (RWIT) of 112 minutes and severe hypoxia caused DGF (0.4%) and SGF (0.4%), respectively, in 2 recipients. Five grafts were lost, including 3 recipients who died with functioning grafts. A mean 42-month graft survival was 98% in the IGF group and 100% in the poor early graft function (PEGF) group, and small numbers in the PEGF group prevented statistical analysis. The presence of diabetes, black recipients, RWIT of ± 60 minutes, donor warm ischemia time (WIT) of ±5 minutes, multiple arteries, obesity, sensitization, re-transplantation, right kidneys, and female donors did not predispose to PEGF.

Conclusion: We found ODN to be associated with excellent IGF and recommend it. We also recommend minimizing the impact of procedural factors with meticulous vascular anastomoses to reduce RWIT, antithymocyte globulin induction (ATG) to avoid calcineurin inhibitor (CNI) nephrotoxicity, cold histidine-tryptophan-ketoglutarate (HTK) perfusion to reduce cellular injury, and maintain optimal oxygenation and filling pressures in the donor and recipient.

Taqi F Toufeeq Khan, Mohammad T Said, Suhaib Kamal, Faheem Akhter, Zakariya Al-Salam

Submitted January 28, 2013 – Accepted for Publication April 22, 2013

KEYWORDS: Living donor kidney transplant, open donor nephrectomy, immediate graft function, poor early graft function, warm ischemia, cold ischemia

CORRESPONDENCE: Taqi F Toufeeq Kahn, Department of Surgery, PO Box 7897/624N, Riyadh Military Hospital, Riyadh, 11159, Saudi Arabia ( taqikahn@yahoo.com)

CITATION: UroToday Int J. 2013 June;6(3):art 30. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.04

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