#801 Impact of delayed graft function on cardiovascular events in kidney transplant recipients

Abstract

Abstract Background and Aims Acute kidney injury (AKI) increases long-term cardiovascular risk in non-transplanted patients. Delayed graft function (DGF) mimics AKI in kidney transplant recipients, yet its impact on their cardiovascular risk remains unclear. Method We investigated the impact of DGF on cardiovascular morbidity and mortality in kidney transplant recipients using data from patients across 17 French centres from the Astre and Divat cohorts. Included patients were aged 18 years or older, transplanted between 2008 and 2022, with follow-up until 31/03/2023. DGF was defined as the need for hemodialysis within the first week following renal transplantation. The primary outcome was the impact of DGF on the occurrence of a cardiovascular event (composite endpoint including cardiovascular death, coronary artery disease, stroke, heart failure), adjusted for conventional cardiovascular risk factors and glomerular filtration rate at 3 months. Analyses were performed using univariate and multivariate Cox models. Results Among the 19, 837 patients transplanted during the inclusion period, 3, 794 experienced DGF (19.1%). In the multivariate Cox model, DGF was strongly associated with cardiovascular risk (adjusted Hazard Ratio [HR] = 1.37, P < .0001), independently of renal function. Other significantly associated variables included age, duration of dialysis, expanded criteria donors, diabetes, dyslipidemia, smoking, initial nephropathy, and various cardiovascular comorbidities. The effect of DGF was predominantly observed in men, patients over 40, and those at lower cardiovascular risk. DGF was associated with independent cardiac outcomes, such as cardiovascular death (HR 1.31), coronaropathy (HR 1.51), heart failure (HR 1.61 and arrhythmia (HR 1.38), but not with stroke (HR 0.99) nor peripheral artery disease (HR 0.97). Conclusion DGF is an independent risk factor for the occurrence of cardiovascular events in kidney transplant recipients. Strategies aimed at minimizing DGF could potentially reduce cardiovascular complications in these patients.