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

Delayed graft function (DGF) is associated with acute rejection (AR) and decreased graft survival, mainly in the early posttransplant period. However, its impact beyond this time is not well known.

All deceased donor kidney-only transplant recipients at our center between June 2005 and December 2019 were stratified based on DGF status (+ versus -). Adjusted hazard ratios (aHRs) of all-cause graft failure (GF), death-censored GF (DCGF), death with a functioning graft (DWFG), and acute rejection (AR) were analyzed within the short-term (0-6 mo) and medium-term (7-36 mo) posttransplant.

Of 3093 recipients, 894 (28.9%) experienced DGF. DGF+ recipients were more likely to be older, male, non-White, differ in causes of end-stage kidney disease and utilization of induction immunosuppression, and had a higher degree of HLA mismatches, pretransplant CAD, and congestive heart failure. Donors of DGF+ recipients had higher body mass index, higher donation after circulatory death, higher terminal serum creatinine and kidney donor profile index, were older, and were less likely to be non-White. In the short term, DGF was associated with an increased risk for GF, DCGF, DWFG, and AR. In the medium term, DGF was associated with an increased risk for GF (aHR: 1.39, 95% confidence interval [CI]: 1.11-1.74, P = 0.004) and DWFG (aHR: 1.56, 95% CI: 1.12-2.18, P = 0.009), but not DCGF (aHR: 1.24, 95% CI: 0.92-1.70, P = 0.16) or AR (aHR: 1.12, 95% CI: 0.78-1.59, P = 0.54).

DGF recipients remained at significantly higher risk of GF and DWFG beyond the first 6 mo. Close follow-up for DGF patients may mitigate these medium-term outcomes.