Kidney Matters - Issue 16 Spring 2022

7
Reducing the incidence of DGF
We would prefer all kidney transplants to work
immediately. It’s easier on the patient, recovery is
much swifter, and it’s easier for us to monitor that
patient during those weeks post-transplant. So, until
we have a safe drug to treat or protect patients from
DGF altogether, we need to keep trying to:
• Shorten the cold ischaemic time
• Maximise the health of the recipient immediately
post-transplant
• Use younger donor organs where possible
The Cardiff transplant team. From left to right: Dr Sarah
Browne, Dr Jonathan Gamble, Mr Michael Stevens, Mr Awad
Alawad, Dr Verrity Brooker
Your medical team will not be alarmed if your
newly transplanted deceased-donor kidney does
not function to full capacity immediately. But it
is inevitable that patients, who have had a lot of
information to absorb in those highly charged hours
immediately prior to their transplant, may not have
fully absorbed this fact and so feel anxious when this
happens to them.
Treating DGF
At the moment there are no drug therapies available
to specifically treat DGF. For those patients with
DGF, they may well need to dialyse for a while posttransplant.
We try to optimise our patient’s blood
pressure and salt levels at this time to give the kidney
the best possible chance of a swift recovery. For
around 99% of patients with DGF, it is a case of just
waiting for the kidney to start to work effectively
before we can send them home. This is usually only a
few days but can sometimes take a few weeks. Very
few patients with DGF lose their transplant completely
and return to dialysis.
At least we do have dialysis as a back-up. Liver and lung
or heart-transplant recipients don’t have this option
if their graft doesn’t start to function immediately.
The option of dialysis to treat DGF helps us in other
ways too. It means that transplant teams can push
the boundaries and transplant more kidneys. Even
if we are pretty sure that a deceased-donor kidney
will be a slow starter, we can still use that organ in
the safe knowledge that our kidney patient will have
the same chance of a good, long-lasting graft, albeit
after a period of dialysis post-transplant, as any other
deceased-donor kidney recipient.
The benefits of receiving a kidney from a
living donor
DGF is far less common if the kidney has been
donated by a living donor: a friend, relative or altruistic
donor. This is because the kidney is more likely to have
been removed from its donor in the same hospital,
resulting in far shorter cold ischaemic time—usually
only two-three hours before it is transplanted—and is
from a person who will have been through a rigorous
work-up over several months to ensure that both the
donor and kidney are in good health.
“This delay in kidney
function is much more
common when the
transplanted kidney
has come from a
deceased donor“
Whilst this work-up is carried out primarily for the
benefit of the donor, the recipient will also benefit as
we know that we are transplanting a very healthy and
compatible kidney with live donor and transplant dates
in the operating theatres. Fewer than 10% of transplant
patients who receive their kidney from a living donor
will experience DGF. This also means we do tend to see
a quicker recovery time in these patients.
Download our patient information
on booklet and go to ‘Frequently
asked questions about kidney
transplantation’ for further
information. Go to
www.kidneycareuk.org/booklets
LEARN MORE
Issue 16 | Spring 2022