The Detrimental Outcomes Associated With Kidney Delayed Graft Function Persist Beyond the Short Term

Area of Science:

• Nephrology
• Transplantation immunology
• Clinical outcomes research

Background:

• Delayed graft function (DGF) is a known risk factor for early post-transplant complications.
• Its long-term impact on kidney transplant outcomes, including graft failure and acute rejection, requires further investigation.

Purpose of the Study:

• To evaluate the association between DGF and medium-term (7-36 months) post-transplant outcomes.
• To determine the risks of graft failure, death-censored graft failure, death with a functioning graft, and acute rejection in DGF recipients.

Main Methods:

• Retrospective analysis of 3093 deceased donor kidney-only transplant recipients (June 2005-December 2019).
• Stratification based on DGF status (present vs. absent).
• Adjusted hazard ratios (aHRs) calculated for short-term (0-6 months) and medium-term (7-36 months) outcomes.

Main Results:

• DGF occurred in 28.9% of recipients.
• Short-term: DGF associated with increased risks of graft failure, death-censored graft failure, death with functioning graft, and acute rejection.
• Medium-term: DGF significantly associated with increased risks of graft failure (aHR: 1.39) and death with functioning graft (aHR: 1.56), but not death-censored graft failure or acute rejection.

Conclusions:

• DGF recipients face a sustained higher risk of graft failure and death with a functioning graft beyond the initial 6 months.
• Intensified patient follow-up may help mitigate these medium-term adverse outcomes.