An Analysis of Modifiable Factors Predictive of Delayed Graft Function in Deceased Donor Renal Transplants

Abstract

Introduction: Delayed graft function (DGF) has demonstrable effects on both the incidence of rejection and long-term survival. Modifiable risk factors for delayed graft function after renal transplant and the implications for graft survival remain poorly defined. Methods: Following IRB approval, records for 713 renal transplants performed between 2005 and 2008 at a large single transplant center were reviewed. DGF was defined as a need for dialysis in the first week after transplant. Paired analysis was conducted using paired donor kidneys where possible. The impact of induction therapy was performed. DGF impact on patient and graft outcomes were also studied. Mean length of follow-up from transplant is 3 years. Results: 300 (42%) of the total 713 recipients developed DGF. In univariate analysis, development of DGF was predicted by days on dialysis (1502 DGF vs. 1173 non-DGF, p=.0003), days on the waitlist (792 DGF vs. 650 non-DGF, p=.0024), creatinine at transplant (8.51 DGF vs. 7.23 non-DGF p< .0001), cold ischemic time (28.71h DGF vs. 23.72h non-DGF p < .0001), donor final creatinine (1.18 DGF vs. 1.03 non-DGF p = 0.0004), recipient and donor BMI were also predictive. Risk of DGF was shown to be independent of left vs. right donor kidneys (OR 1.02). Kidneys from Caucasian donors were nearly twice as likely to develop DGF (OR 1.89) than kidneys from African American donors. Neither D+/R- CMV status, donor CMV status nor number of HLA mismatches were shown to be predictive of DGF.Figure: [DGF Risk Factors]Among induction therapies, 39% of patients who received Simulect developed DGF compared with 42% who received Thymoglobulin and 47% who received Campath. Development of DGF was shown to be predictive of reduced renal function (at 1 year, DGF Cr was 2.08 vs. 1.60 in the non-DGF population, p < .0001). DGF was not a predictor of all-cause mortality, but it was a predictor of retransplant. Conclusions: This is a large single center retrospective study which evaluates modifiable risk factors for the development of renal transplant DGF in a population where the incidence is high. Efforts in decreasing DGF should focus, in part, to factors which have been demonstrated to be highly predictive.