Evaluation of severity of delayed graft function in kidney transplant recipients

• Published in: Nephrology, dialysis, transplantation Vol. 37; no. 5; pp. 973 - 981
• Main Authors: Schrezenmeier, Eva, Müller, Mia, Friedersdorff, Frank, Khadzhynov, Dmytro, Halleck, Fabian, Staeck, Oliver, Dürr, Michael, Zhang, Kun, Eckardt, Kai-Uwe, Budde, Klemens, Lehner, Lukas J
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 25.04.2022
• Subjects: Delayed Graft Function - etiology; Graft Rejection - etiology; Graft Survival; Humans; Kidney Transplantation - adverse effects; Renal Dialysis - adverse effects; Retrospective Studies; Risk Factors; Tissue Donors; KDPI; hospitalization; delayed graft function; rejection; kidney transplantation
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfab304

ABSTRACT Background The most common definition of delayed graft function (DGF) relies on dialysis during the first week post-transplant and does not consider DGF severity. The impact of DGF severity on long-term graft outcome remains controversial. Methods We analysed 627 deceased-donor kidney transplant recipients (KTRs) transplanted in 2005–2015 at our centre for DGF severity, associated risk factors and long-term consequences of DGF. Results We found 349 (55.7%) KTRs with DGF, which were classified into four groups according to DGF duration (0–1, 2–7, 8–14, >14 days) and were compared with KTR with no DGF. A longer duration of DGF was associated with progressive worsening of 10-year death-censored graft survival {no DGF: 88.3% [95% confidence interval (CI) 82.4–94.2]; 0–1 day: 81.3% [95% CI 68.2–94.4], 2–7 days: 61.5% [95% CI 43.1.1–79.9], 8–14 days: 66.6% [95% CI 47.4–85.8], >14 days: 51.2% [95% CI 33–69.4]; P < 0.001}. In kidneys with a Kidney Donor Profile Index (KDPI) ≥85%, all DGF severity groups demonstrated reduced graft survival. However, in the <85% KDPI kidneys, only >14 days DGF duration showed worse outcomes. Conclusions DGF had a duration-dependent effect on graft survival, which varied depending on the KDPI. Of note, 0- to 1-day DGF showed comparable results to no DGF in the whole cohort.