Association of delayed graft function with cardiovascular outcomes in kidney transplant recipients

Cardiovascular disease remains a major cause of morbidity and mortality in kidney transplant recipients. This multicenter cohort study examined the association between delayed graft function (DGF) and major adverse cardiovascular events (MACEs) in a cohort of 18 149 kidney transplant recipients from 17 French hospitals, transplanted between 2008 and 2022. The primary outcome measured was the incidence of MACEs, including cardiovascular death, coronary artery disease, heart failure, and stroke, with secondary outcomes of graft failure and noncardiovascular death. Among the cohort, 4182 (23.0%) experienced DGF, which was associated with a significantly increased risk of MACEs (hazard ratio: 1.24, 95% confidence interval: 1.10-1.40), particularly coronary artery disease, heart failure, and cardiovascular death, but not stroke. The association of DGF with an increased MACE incidence remained consistent over time (P-interaction = .19) and intensified with greater DGF severity, as measured by the number of dialysis sessions required after transplantation (P-trend = .01). Graft function did not significantly mediate the association between DGF and MACEs (P = .62). These findings suggest that the renal lesions resulting from DGF may mediate cardiovascular risk, highlighting the need for optimized prevention and treatment strategies to improve patient outcomes.