Factors Predicting Duration of Delayed Graft Function in Non-Heart-Beating Donor Kidney Transplantation J. Asher, C. Wilson, M. Gok, S. Balupuri, A.A. Bhatti, N. Soomro, D. Rix, B. Jaques, D. Manas, B. Shenton, and D. Talbot ABSTRACT Non-heart-beating donors (NHBDs) are an important potential source of donor organs, but kidneys from such donors are prone to delayed graft function (DGF) and primary nonfunction, which are multifactorial in origin but believed to be mainly due to warm ischemic injury. This retrospective study examined a series of 88 transplants from Maastricht category II and III NHBDs to examine the role of factors to predict the duration of DGF. The main factors affecting duration of DGF were total warm ischemic time, cold ischemic time, product of perfusate GST concentration and donor age, quality of postoperative graft perfusion, incidence of acute rejection, recipient cardiovascular risk score, maximum pressure on machine perfusion, and weight gain during machine perfusion. Primary nonfunction was not accurately predicted from these factors for kidneys that had passed the viability assessment. N ON-HEART-BEATING DONOR (NHBD) kidney transplants offer the opportunity to compensate for the growing discrepancy between supply and demand for donor kidneys. 1,2 They have been shown to have the same survival and long-term function as kidneys from traditional brain-stem dead donors 3 but are associated with a higher incidence of primary nonfunction and a higher incidence and duration of delayed graft function (DGF). 4 These are probably due to the inevitable primary warm ischemic injury associated with NHBD, although other factors may play a role. We aimed to evaluate the possible factors predicting the duration of DGF because prolonged DGF has the potential to cause morbidity due to additional dialysis requirements and prolonged hospital stay, as well as psychological morbidity in patients who see nonfunction of their graft. We also anticipate that the factors associ- ated with prolonged DGF may increase the incidence of primary nonfunction, thereby with a deleterious effect on graft survival. MATERIALS AND METHODS We reviewed our series of 88 consecutive Maastricht category II and III NHBD kidney transplants from 1998 to 2004 to analyze the impact of possible predictors of DGF duration. The collective role of these predictors was further evaluated using a multiple regres- sion analysis model. The cut-off values or methods of grouping of the factors are shown in Table 1. RESULTS Factors individually predicting significant differences in duration of DGF included ideal DTPA perfusion (mean duration 9 vs 22 days, P = .015, MWU); incidence of acute rejection (8.6 vs 14 days, P = .003, Kruskal-Wallis test); product of GST and donor age (9.2 vs 28.1 days, P = .001, MWU); kidney weight gain on machine perfusion (9.2 vs 18.9 days, P = .018, MWU); maximum systolic pressure on machine perfusion (8.2 vs 17.4 days, P = .021, t test); recipient cardiovascular risk score (10.3 vs 21.0 days, P = .017, t test) and total warm ischemic time (8.4 vs 16.8 days, P = .042, t test). The multiple regression model demonstrated the diffi- culty of predicting the duration of DGF as the best model only achieved r 2 = 0.493 (r = 0.702, P = .014; Durbin- Watson statistic 1.901). The factors, in order of importance, were: DTPA perfusion scan score; product of perfusate From the Liver and Renal Transplant Unit, Freeman Hospital (J.A., C.W., M.G., S.B., A.A.B., N.S., D.R., B.J., D.M., D.T.), and Department of Surgery, University of Newcastle upon Tyne (J.A., C.W., B.S.), Newcastle upon Tyne, UK. Funded by Northern Counties Kidney Research Fund and the Newcastle upon Tyne Hospitals NHS Trust. Address reprint requests to Dr John Asher, Liver and Renal Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom. E-mail: john.asher@btinternet.com 0041-1345/05/$–see front matter © 2005 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2004.11.036 360 Park Avenue South, New York, NY 10010-1710 348 Transplantation Proceedings, 37, 348 –349 (2005)