Identifying Causes and Risk Factors of 7-Day Graft Loss in Kidney Transplantation: A UNOS-Based Analysis

Despite advancements in organ procurement, immunosuppression, and infection prophylaxis, early graft loss remains a challenge in kidney transplantation. We aimed to identify key recipient-, donor-, and transplant-related factors associated with 7-day graft loss.

We conducted a retrospective analysis (January 1, 2015-June 30, 2024) by using the United Network for Organ Sharing database to compare kidney recipients who experienced 7-day graft loss with those with graft survival of >1 year.

Among 136 815 kidney transplant recipients from living and deceased donors, 1046 (0.76%) had 7-day graft loss. Causes of overall and deceased donor 7-day graft loss included primary nonfunction, graft thrombosis, and rejection. Causes of 7-day graft loss for living donor recipients included primary nonfunction, rejection, technical complications, and recurrent disease. Significant predictors of deceased donor 7-day graft loss included recipient body mass index (odds ratio 1.034, P < .001), hypertension (odds ratio 1.285, P = .001), donation after circulatory death (odds ratio 1.349, P < .001), kidney donor profile index (OR 15.402, P < .001), cold ischemia time (odds ratio 1.014, P = .002), and modern transplant era (years 2020-2024) (odds ratio 1.679, P < .001). Predictors of living donor 7-day graft loss included focal segmental glomerulosclerosis (odds ratio 2.481, P = .018), donor age (odds ratio 1.027, P = .015), modern era (odds ratio 1.811, P = .033), and antithymocyte globulin and interleukin 2 induction (odds ratio 3.697, P = .015). Risk factors for deceased donor 7-day mortality included type 2 diabetes mellitus (odds ratio 2.396, P = .031) and primary nonfunction (odds ratio 12.868, P = .013).

Seven-day graft loss is associated with identifiable causes and risk factors. This underscores the importance of recipient management and donor selection.