The effect of pre-operative methylprednisolone on the incidence of delayed graft function in renal transplantation

Abstract

Introduction: This study explores the effect of different corticosteroid administration timings on the incidence of slow/delayed graft function. Methods: One hundred and twelve kidney transplants from January 2011 to March 2014 were retrospectively analysed. Thirty-six cases were excluded because they were donor-specific antibody positive ( n =16), received thymoglobulin/plasma exchange ( n =11), were ABO-incompatible ( n =6) or suffered graft loss from vascular thrombosis within the first week post-transplant ( n =3). The study period straddled three eras of corticosteroid administration, from intra-operative intravenous (IV) hydrocortisone (Era 1; n =26), to intra-operative IV methylprednisolone (Era 2; n =38) and pre-operative IV methylprednisolone (Era 3; n =12). The primary endpoint was the incidence of slow/delayed graft function. Secondary outcomes included estimated glomerular filtration rate at discharge and 120 and 365 days, rejection (acute and one-year), wound complications, post-transplant diabetes, increase in low-density lipoprotein or body mass index, and cytomegalovirus or BK viraemia within one year. Results: On univariate analysis, pre-operative methylprednisolone was associated with lower incidence of slow/delayed graft function (17%, 55%, 58% in Eras 3, 2, 1 respectively; p =0.041), superior estimated glomerular filtration rate at discharge (median 56, 37 and 43 ml/min for Eras 3, 2, 1 respectively; p =0.033) and at 120 days (median 60, 52, and 46 ml/min for Eras 3, 2, 1 respectively; p =0.017). On multivariate analysis, pre-operative IV methylprednisolone ( vs . Eras 1 and 2 combined; odds ratio 4.79 (90% confidence interval 1.16–19.80); p =0.07) and living donor type ( vs . deceased; odds ratio 5.56 (90% confidence interval 2.25–13.77); p =0.002) were associated with lower incidence of slow/delayed graft function. Conclusion: Pre-operative methylprednisolone was associated with reduced slow/delayed graft function and improved early estimated glomerular filtration.