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Risk factors and outcomes for delayed kidney graft function in simultaneous heart and kidney transplant recipients: A

Sandesh Parajuli1, Aos S Karim2, Brenda L Muth1

  • 1Division of Nephrology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|February 10, 2021
PubMed

Insights

Kidney delayed graft function (K-DGF) after simultaneous heart and kidney transplants is linked to higher mortality and graft failure. Pre-transplant dialysis and longer cold ischemia time are key risk factors for K-DGF.

Area of Science:

  • Nephrology
  • Cardiology
  • Transplant Surgery

Background:

  • Kidney delayed graft function (K-DGF) is a known complication after kidney transplantation.
  • However, risk factors and outcomes for K-DGF in simultaneous heart and kidney (SHK) transplant recipients remain unstudied.
  • This study addresses this gap in knowledge for a unique patient population.

Purpose of the Study:

  • To identify risk factors for developing K-DGF in SHK transplant recipients.
  • To determine the outcomes associated with K-DGF in this population.
  • To provide insights for improving peri-operative management and donor-recipient matching.

Main Methods:

  • Utilized the OPTN/UNOS database for SHK transplant data from 1998-2018.
  • Analyzed 1161 SHK recipients, categorizing them into K-DGF (+) and K-DGF (-) groups.
  • Employed multivariable analysis to identify significant risk factors and outcome predictors.

Main Results:

  • Pre-transplant dialysis history (OR: 3.95) was a significant risk factor for K-DGF.
  • Longer cold ischemia time for either organ and donor death from cerebrovascular accident also increased K-DGF risk.
  • K-DGF was associated with increased mortality (HR: 1.99) and kidney graft failure (HR: 3.51).

Conclusions:

  • K-DGF in SHK recipients is associated with significantly worse patient and graft outcomes.
  • Risk factors identified include pre-transplant dialysis and prolonged cold ischemia time.
  • Optimizing donor-recipient matching and peri-operative care may mitigate K-DGF risk and its adverse effects.

Keywords:
clinical research/practicedelayed graft function (DGF)graft survivalheart transplantation/cardiologykidney transplantation/nephrologypatient survival

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