Factors Associated with Delayed Graft Function and Renal Graft Survival from Donors after Controlled Cardiac Death

Delayed graft function is a common situation that leads to increased long-term rates of graft rejection and loss. It is seen increasingly more often, as the use of kidneys from donors after controlled cardiac death has become more widespread. This study aimed to identify factors contributing to its onset and determine how these factors may influence graft survival.

This study analysed kidney transplants with grafts from donors after controlled cardiac death performed at our hospital since the start of program in March 2013 until December 2023. Data on delayed graft function presence, graft survival, and variables related to donor, recipient, harvesting technique, ischemia time and surgical complications were collected.

Recipients (male sex, 69%; Mean age, 57.9 years) received replacement renal therapy (haemodialysis in 47.6%) for a mean of 1.8 years. Amongst the donors, 73% presented expanded criteria. Ultrarapid technique was used in 61.1%, with a total warm ischemia time of 22.3 min. In all, 49 (38.9%) patients experienced delayed graft function. According to a multivariate analysis, this finding was associated with time on dialysis treatment (odds ratio (OR), 2.3; p = 0.02), donor history of diabetes mellitus (OR, 11.0; p = 0.03), score ≥3 on renal graft biopsy (OR, 4.9; p = 0.02), use of ultrarapid techniques compared with abdominal normothermic regional perfusion with extracorporeal membrane oxygenation (OR, 55.0; p = 0.03) and longer warm ischemia time (OR, 1.1; p = 0.02). Graft function was lost by 16 (12.7%) patients after a mean follow-up of 4.1 years (standard deviation (SD), 2.8). The likelihood of graft survival was 93% at 5 years. The presence of delayed graft function did not increase the rate of graft loss (p = 0.127); However, when only late losses were considered, 16.7% of kidneys with delayed graft function were lost vs. 4.1% without delayed graft function (p = 0.022).

In kidney transplants from donation after cardiac death, delayed graft function is associated with reduced graft survival. The incidence can be lowered by factors such as perfusion with extracorporeal membrane oxygenation, harvest techniques and shorter warm ischemia times.