A delayed wake-up call: Is perioperative sleep contributing to delayed graft function?

Abstract

Renal transplantation offers dialysis-dependent patients a new lease on life. Compared with chronic dialysis, kidney transplant recipients benefit from a substantially improved quality and quantity of life. Despite increases in age and comorbidity among contemporary transplant recipients, recipients can expect substantial decreases in all-cause mortality, hospitalizations from infections (despite the required immunosuppression), and cardiovascular events. Invariably, the benefits of transplantation require the ongoing survival and function of the graft. Long-term graft function and patient survival are correlated with graft function in the immediate postoperative period. However, in up to 30% of cases, a wide range of clinical factors contribute to insufficient graft function, requiring transplant recipients to undergo further dialysis in a complication referred to as delayed graft function. An intermediate phenotype, slow graft function, is characterized by slower postoperative declines in creatinine without the need for dialysis and is similarly associated with long-term graft failure. These postoperative complications also confer additional costs to the health care system, with more intensive and protracted hospital stays. Delayed graft function and slow graft function continue to be major obstacles in allograft and patient survival; however, a possible contributing factor that requires further attention is perioperative sleep.