Comprehensive Review
Delayed Graft Function in the Kidney Transplant

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Acute kidney injury occurs with kidney transplantation and too frequently progresses to the clinical diagnosis of delayed graft function (DGF). Poor kidney function in the first week of graft life is detrimental to the longevity of the allograft. Challenges to understand the root cause of DGF include several pathologic contributors derived from the donor (ischemic injury, inflammatory signaling) and recipient (reperfusion injury, the innate immune response and the adaptive immune response). Progressive demand for renal allografts has generated new organ categories that continue to carry high risk for DGF for deceased donor organ transplantation. New therapies seek to subdue the inflammatory response in organs with high likelihood to benefit from intervention. Future success in suppressing the development of DGF will require a concerted effort to anticipate and treat tissue injury throughout the arc of the transplantation process.

Key words:

Delayed graft function
immune mediators
ischemia
kidney transplantation
reperfusion injury

Abbreviations:

ADP
adenine dinucleotide
AKI
acute kidney injury
AMP
adenine mononucleotide
ATG
antithymocyte globulin
ATN
acute tubular necrosis
ATP
adenine trinucleotide
Bcl-2
B-cell lymphoma 2
C3
complement component C3
CAN
chronic allograft nephropathy
CCB
calcium channel blockers
CCL
C-C motif chemokine receptor ligand
CNI
calcineurin inhibitor
CO
carbon monoxide
CXCR2
C-X-C motif chemokine 2 receptor
CXCR3
C-X-C motif chemokine 3 receptor
DDRA
deceased donor renal allografts
DGF
delayed graft function
eNOS
endothelium-derived NOS
ET-1
endothelin
GPCR
G protein coupled receptors
HTK
histidine–tryptophan–ketoglutarate
HMBG-1
nonhistone chromatin binding protein high-mobility group box 1
HO-1
hemo oxygenase 1
HSP
heat-shock protein
ICAM-1
intercellular adhesion molecule-1
IFN-gamma
interferon gamma
KIM-1
kidney injury molecule-1
LFA-1
lymphocyte functioning antigen-1
LRDA
living-related donor renal allografts
Mac-1
macrophage-1
MGP
matrix Gla protein
MHC
major histocompatibility complex
mir21
microRNA 21
MRP2
multidrug resistance-related protein 2
NADH
nicotinamide adenine dinucleotide
NO
nitric oxide
OPTN
Organ Procurement and Transplantation Network
ROC
receiver operator curve
rPSGL-Ig
recombinant P-selectin glycoprotein ligand IgG fusion protein
S100A4
calcium-binding protein A4
SCD
standard criteria donor
siRNA
small inhibitory microRNA
SNP
single nucleotide polymorphisms
TLR
Toll-like receptors
TMZ
trimetazidine
TNF
tumor necrosis factor
uNGAL
urinary neutrophil gelatinase associated lipocalin
UNOS
United Network for Organ Sharing
UW
University of Wisconsin lactobionate/raffinose solution
VCAM-1
vascular cell adhesion molecule-1
VLA-4
very late antigen-4
Wnt-1
Wingless- int-1
XD
xanthine dehydrogenase
XOR
xanthine oxidoreductase

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