Delayed graft function post renal transplantation: a review on animal models and therapeutics

Abstract

The incidence of end-stage renal disease (ESRD) has been increasing worldwide. Its treatment involves renal replacement therapy, either by dialyses or renal transplantation from a living or deceased donor. Although the initial mortality rates for patients on dialysis are comparable with kidney transplant recipients, the quality of life and long-term prognosis are greatly improved in transplanted patients. However, there is a large gap between availability and need for donor kidneys. This has led to the increase in the use of expanded kidney donor criteria. Allograft dysfunction immediately after transplant sets it up for many complications, such as acute rejection and shorter allograft survival. Delayed graft function (DGF) is one of the immediate posttransplant insults to the kidney allograft, which is increasing in prevalence due to efforts to maximize the available donor pool for kidneys and use of expanded kidney donor criteria. In this review, we discuss the risk factors for DGF, its implications for long-term allograft survival, animal models of DGF, and the therapeutic options currently under evaluation for prevention and management of DGF.

Keywords: acute kidney injury; delayed graft function; kidney transplant; therapeutics.

Graphical abstract

Figure 1.

Risk factors for delayed graft function (adapted from Refs. and 11). Here we display the various risk factors that drive delayed graft function; these factors include donor-related, kidney-related, and recipient-related factors.

Figure 2.

Mechanisms of delayed graft function. Highlighted are the many and diverse mechanisms that affect delayed graft function, including both pre- and posttransplant as well as the cellular interactions that drive injury progression.