Funzione ritardata del trapianto renale da danno ischemico reversibile. Fattori di rischio e prognosi a breve e a lungo termine

The primary non function of a kidney graft due to acute tubular necrosis can negatively affect outcome. In order to evaluate this possibility in our patients the clinical evolution of 450 first cadaver grafts has been studied. Diagnosis of acute tubular necrosis was considered for exclusion of other causes of graft malfunction and the acute tubular necrosis was defined mild (less than 3 post-operative dialysis) or severe. The early outcome of kidney with severe acute tubular necrosis (130) was statistically poorer but after the first six months the negative effect disappears. Three of the possible causes of acute tubular necrosis we could modify were studied: multiple organ harvesting, which does not affect the outcome in our cases, the cyclosporine treatment, which increases the incidence of acute tubular necrosis and the cold ischemical time, which has a negative effect even for the short periods we considered safe. In particular the incidence of acute tubular necrosis was singnificantly higher in the second kidney of 153 pairs which were transplanted one after the other with only an average of seven further hours of cold preservation.