Introduction: The estimated frequency of delayed graft function (DGF) in Brazil ranges from 50 to 70%, despite deceased donor and recipient characteristics similar to those reported in USA and Europe. To date, no study has evaluated the risk factors for this high DGF rate. It is speculated that this is due to the suboptimal maintenance care of potential donors before organ retrieval. Methods: This study prospectively evaluated the expected and the observed incidence of DGF (according to DGF calculator, available on www.transplantcalculator.com) in 214 deceased kidney transplants (KT) performed in two Brazilian centers between Jan 2015 and Oct 2016. Both centers are located in a region with high-performance organ procurement, a small KT waiting list, and with locally predominant use of ideal donors. Recipients under 16yo and machine perfused kidneys were excluded. Risk factors for DGF were evaluated in a multivariable analysis. DGF was defined as the need for dialysis in the first week after transplantation.Results: KT patients were predominantly men (58%), young (43±15yo), overweight (BMI 27±4kg/m²), mixed race (81%), with unknown etiology of CKD (32%) and 47±48 months on dialysis. Retransplants were 8%, with PRA of 11±24%, and 6% presented DSA. Donors were predominantly young (32±13yo), slightly overweight (BMI 25±2kg/m²), non-hypertensive (94%), with a good terminal serum creatinine (1.1±0.6mg/dL), who died due to cranial trauma (73%), and 96% were standard criteria donors. 12% had reversed cardiac arrest and 95% in use of vasoactive drugs. Mean serum Na+ and CPK were 158±18mEq/L and 1,584±257 UI/L, respectively. All donors were brain dead (DBD) and cold ischemia time (CIT) was 21±5h. The estimated DGF was 16% and the observed DGF was 52%. In multivariable analysis, risk factors for DGF was time on dialysis (OR 1.025, 95%CI 1.007-1.043, p=0.006), CIT (OR 1.205, 95%CI 1.049-1.382, p=0.008), donor BMI (OR 1.231, 95% CI 1.013-1.497, p=0.037), and donor CPK (OR 1.000, 95%CI 1.000-1.001, p=0.039). Conclusion: The observed incidence of DGF in this cohort of KT from ideal deceased donors was 3-fold higher than the expected. In addition to the traditional risk factors, such as time on dialysis, BMI and CIT, donor CPK was independently associated with DGF, suggesting the important role of donor hemodynamic conditions.

CITATION INFORMATION: Costa S, Sandes-Freitas T, Daher E, Esmeraldo R. Risk Prediction Model for Delayed Graft Function in a Cohort of Brazilian Kidney Transplantation from Deceased Donors: What You See Is Not What You Get. Am J Transplant. 2017;17 (suppl 3).

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