Tissue thiamine deficiency as potential cause of delayed graft function after kidney transplantation: thiamine supplementation of kidney donors may improve transplantation outcome

Delayed graft function is an important medical problem after renal transplantation. It occurs in approximately 30% of cases, and is not only associated with more prolonged and complicated hospitalisation, but also with earlier graft loss on the long-term. Delayed graft function is the consequence of acute tubular necrosis caused by ischaemia-reperfusion injury, with insufficiently opposed toxic effects of reactive oxygen species and insufficient ATP regeneration. An optimal tissue thiamine status is pivotal for scavenging of reactive oxygen species and regeneration of ATP. There are several reasons to suppose that tissue thiamine availability is suboptimal in donor kidneys prior to reperfusion in transplantation. These reasons include a high prevalence of untreated thiamine deficiency at admission of donors to intensive care units, quick exhaustion of body thiamine stores during periods of non-feeding or inappropriate feeding during hospital stays of donors, and loss of the water-soluble vitamin into water-based organ preservation solutions. We therefore hypothesize that a suboptimal tissue thiamine status is a cause of delayed graft function after renal transplantation, and that it can be prevented with thiamine supplementation.