Delayed Graft Function Is a Strong Negative Outcome Predictor in Kidney Transplant Recipients Independent of Surveillance Biopsy Findings.

Abstract

Multiple factors contribute to occurrence of delayed graft function (DGF) in renal allografts. We wished to evaluate the impact of DGF in 135 transplant patients that received surveillance biopsies at 3months post transplantation at our institution between Jan 2004 and Jun 2010. Patients with no biopsies or for-cause biopsies were excluded. We recorded clinical characteristics, outcomes, rejection diagnosis and semi-quantitative histological scores of inflammation and fibrosis seen on biopsies. Patients that experienced DGF had longer cold ischemia times; no other significant differences were observed in baseline and biopsy characteristics. Rejection severity was mild.Table: No Caption available.Table: No Caption available.The average follow up time was similar. The DGF group exhibited significantly higher creatinine levels at 1 and 3 years after transplantation. Kaplan-Meier survival curves are shown, log-rank test=0.07.Figure: No Caption available.The cumulative incidence of death and graft failure was not significantly different, however, on time to event analysis, the presence of DGF was associated with an unadjusted risk for death and allograft failure of 3.26(95%CI:.92,11.6), p=0.07 and 4.79(95%CI: 1.3, 17.7), p=0.019, after adjustment for rejection and creatinine levels at biopsy. Our results suggest a significant negative prognosis conferred by presence of DGF in relation to allograft function and survival. This effect appears independent of histological changes detected on the 3month surveillance biopsies. DISCLOSURES:Leca, N.: Grant/Research Support, Investigator initiated research Novartis.