Introduction: Oxidative stress has been implicated in complications after kidney transplantation (KT), including delayed graft function (DGF) and rejection. However, its role in long-term posttransplant outcomes remains unclear. Methods: We investigated oxidative damage and antioxidant defense dynamics, and their impact on the graft outcomes, in 41 KT recipients categorized by type of donation over 12 months. Oxidative status was determined using OxyScore and AntioxyScore indexes, which comprise several circulating biomarkers of oxidative damage and antioxidant defense. Donor types included donation after brain death (DBD [61.0%]), donation after circulatory death (DCD [26.8%]), and living donation (LD [12.1%]). Results: There was an overall increase in oxidative damage early after transplantation, which was significantly higher in DCD as compared to DBD and LD recipients. The multivariate adjustment confirmed the independent association of OxyScore and type of deceased donation with DGF, donor kidney function, and induction therapy with antithymocyte globulin. There were no differences in terms of antioxidant defense. Lower oxidative damage at day 7 predicted better graft function at 1-year posttransplant only in DBD recipients. Conclusion: DCD induced greater short-term oxidative damage after KT, whereas the early levels of oxidative damage were predictive of the graft function 1 year after KT among DBD recipients.

With advancements in therapies reducing the risk of graft-associated complications after kidney transplantation (KT), our focus shifts toward ensuring optimal graft conditions to improve the quality of life for KT patients. This emphasizes the importance of identifying prognostic factors of kidney function, even in populations without graft-associated complications. Oxidative stress, which is characterized by an imbalance in the production and neutralization of free radicals in the body, has been linked to graft-associated complications. Moreover, a significant determinant of graft function is the source of the graft, whether obtained from living donation (LD) or donation after circulatory or brain death (DCD and DBD). Therefore, we aimed to study whether oxidative stress differed in the short-term after KT in patients receiving LD, DCD, and DBD, and whether these levels of oxidative stress were predictive of graft function in KT patients without long-term complications such as rejection. We examined oxidative stress in 41 KT recipients over 12 months, finding increased oxidative damage early post-KT, notably higher in DCD donors. Moreover, lower oxidative damage in the first week after KT predicted better 1-year graft function in DBD recipients. In conclusion, DCD induced more short-term oxidative damage, while early oxidative levels predicted 1-year graft function in DBD recipients. These findings underscore the importance of early oxidative stress assessment in guiding clinical decision-making and optimizing long-term outcomes in KT recipients.

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