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The Association Between Early Graft Function, Donor Type and Long-Term Kidney Transplant Outcomes.
Karthik Venkataraman1,2,3, Georgina L Irish1,2,3, Michael G Collins1,2,3
1Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
Summary
Slow graft function (SGF) and delayed graft function (DGF) after kidney transplants are linked to worse outcomes. SGF negatively impacts graft survival in living donor and brain death donors, while DGF affects all donor types.
Area of Science:
- Nephrology
- Transplantation immunology
- Clinical outcomes research
Background:
- Delayed graft function (DGF) is a known risk factor for kidney transplant recipients.
- The impact of slow graft function (SGF), defined as <30% creatinine drop between days 1-2, on transplant outcomes remains unclear.
Purpose of the Study:
- To investigate the association between SGF, DGF, and kidney transplant outcomes across different donor types.
- To compare the effects of SGF and DGF on graft survival, death-censored graft survival, patient survival, and graft function.
Main Methods:
- Retrospective cohort study of 17,579 Australian and New Zealand kidney transplant recipients (2001-2021).
- Defined SGF as serum creatinine dropping by less than 30% between post-transplant days 1 and 2.
- Analyzed associations with graft survival, death-censored graft survival, patient survival, estimated glomerular filtration rate (eGFR), and rejection, stratified by donor type (living donor, donation after brain death [DBD], donation after circulatory death [DCD]).
Main Results:
- Both SGF and DGF were associated with reduced graft survival in living donor and DBD recipients.
- DGF, but not SGF, was associated with reduced graft survival in DCD recipients.
- SGF was linked to reduced patient survival in living donor recipients.
- SGF and DGF were associated with lower 12-month eGFR across all donor types.
- DGF increased rejection odds for all donor types; SGF only for DBD recipients.
Conclusions:
- SGF is associated with adverse graft and patient outcomes in kidney transplant recipients, particularly those with living donors or from DBD donors.
- DGF consistently predicts poorer outcomes across all donor types.
- These findings highlight the importance of monitoring early graft function beyond just DGF to identify at-risk patients.
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