Abstract
Introduction:Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated.Objective:The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function.Methods:A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013.Results:The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival.Conclusions:The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.
Highlights
Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant
Graft- and transplant surgery-related factors were: cold ischemia time, pre-implantation biopsy and organs coming from another Brazilian state and transplanted in our center as per the Brazilian regulations for organ allocation (“out-of-state” organs)
Cold ischemia time was measured from the organ cooling within the donor up to being withdrawn from preservation solution, and warm ischemia time was measured from this point up to vascular clamps release
Summary
Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. The occurrence of DGF was associated with a higher incidence of Banff ≥ 1A grade acute rejection (p = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (p < 0.05). Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant.[1] DGF has many definitions and currently the most commonly employed is the need for dialysis within the first week after transplantation.[2] Its overall incidence, according to the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients 2012 Annual Data Report, is stable around 24% in the United States of America.[3] much higher incidence rates have been observed in many countries, in Brazil, for reasons that are not entirely clear but that are probably related to suboptimal donor maintenance.[4]. Higher mortality has been reported in patients with DGF.[5]
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