Delayed renal graft function: risk factors and impact on the outcome of transplantation

The objectives of this study were to determine whether delayed graft function (DGF) implied a higher incidence of poor prognostic markers and to determine its impact on renal transplantation outcomes, particularly graft and patient survivals.

This retrospective study included 997 cadaveric kidney transplantations between January 1, 1996 and December 31, 2007. Two groups were created: immediate diuresis (ID; n = 803; 80.5%) and DGF (n = 194; 19.5%).

These donor related variables showed significant differences (P < .05): age (ID, 35.20 ± 15.681; DGF, 42.49 ± 16.316), weight (ID, 70.54 ± 12.896; DGF, 74.86 ± 14.402), death cause (stroke: ID, 24.9%; DGF, 42.6%), hourly urinary output (ID, 225.55 ± 168.107; DGF, 187.29 ± 125.623), and creatinine (ID, 1.004 ± 0.3737; DGF, 1.075 ± 0. 4148). The significant recipient-related age (ID, 42.95 ± 13.095; DGF, 45.57 ± 13.138), dialysis time ID, 39.41 ± 38.172; DGF, factors were as follows 56.14 ± 44.243), dialysis type, and comorbidities. The significant transplant-related variables were follows: cold ischemia time (ID, 19.489 ± 4.841; DGF, 21.469 ± 5.297) and surgery duration (ID, 2.549 ± 1.105; DGF, 3.028 ± 1.738). Acute rejection and chronic allograft nephropathy (CAN) were greater among the DGF group (ID, 27.3% and 15.0% and DGF, 55.2% and 34.0%, respectively). Average graft (ID, 127.8 months; DGF, 93.9 months) and patient survival (ID, 143.2 months; DGF, 125.6 months) were higher in patients with ID. Multivariate analysis identified these independent risk factors for graft loss: CAN (hazard ratio [HR], 3.30) and DGF (HR, 2.30) but neither had an influence on patient survival.

DGF was associated with multiple risk factors and contributed to worse graft outcomes. It is an independent risk factor for graft loss and an important marker of other factors that affect decisively the outcome of renal transplantation.