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Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation

  • Urology - Original Paper
  • Published:
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Abstract

Background

Delayed graft function (DGF) is a manifestation of acute kidney injury uniquely framed within the transplant process and a predictor of poor long-term graft function1. It is less common in the setting of living donor (LD) kidney transplantation. However, the detrimental impact of DGF on graft survival is more pronounced in LD2.

Purpose

To study the effects of DGF in the setting of LD kidney transplantation.

Methods

We performed a retrospective analysis of LD kidney transplantations performed between 2010 and 2018 in the UNOS/OPTN database for DGF and its effect on graft survival.

Results

A total of 42,736 LD recipients were identified, of whom 1115 (2.6%) developed DGF. Recipient dialysis status, male gender, diabetes, end-stage renal disease, donor age, right donor nephrectomy, panel reactive antibodies, HLA mismatch, and cold ischemia time were independent predictors of DGF. Three-year graft survival in patients with and without DGF was 89% and 95%, respectively. DGF was the greatest predictor of graft failure at three years (hazard ratio = 1.766, 95% CI: 1.514–2.059, P = 0.001) and was associated with higher rates of rejection (9% vs. 6.28%, P = 0.0003). Among patients with DGF, the graft survival rates with and without rejection were not different.

Conclusion

DGF is a major determinant of poor graft functional outcomes, independent of rejection.

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Availability of data and material

Available in UNOS/OPTN registry.

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Authors and Affiliations

  1. Department of Urology and Renal Transplant, University of Toledo, 3000, Arlington Ave, MS1091, Toledo, OH, 43614, USA

    Shivashankar Damodaran, Obi Ekwenna, Puneet Sindhwani & Jorge Ortiz

  2. College of Medicine and Life Sciences, University of Toledo, 3000, Arlington Ave, Toledo, OH, 43614, USA

    Brenna Bullock

  3. Schar School of Policy and Government, George Mason University, Arlington Campus, Van Metre Hall 520, 3351 N. Fairfax Dr. MS#3B1, Arlington, VA, 22201, USA

    Mehdi Nayebpour & Naoru Koizumi

  4. Department of Surgery and Kidney Transplant, University of Toledo, 3000, Arlington Ave, MS1095, Toledo, OH, 43614, USA

    Shivashankar Damodaran, Brenna Bullock, Obi Ekwenna, Mehdi Nayebpour, Naoru Koizumi, Puneet Sindhwani & Jorge Ortiz

Authors
  1. Shivashankar Damodaran
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  2. Brenna Bullock
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  3. Obi Ekwenna
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  4. Mehdi Nayebpour
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  5. Naoru Koizumi
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  6. Puneet Sindhwani
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  7. Jorge Ortiz
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Contributions

SD: concept/design, Data analysis/interpretation, Drafting article, Critical revision of article. BB: drafting article, critical revision of article. MN: data analysis/interpretation, Statistics, Data collection. NK: data analysis/interpretation, Statistics, Data collection. OE—Critical revision of article, Approval of article. PS: critical revision of article, Approval of article. JO: concept/design, Data analysis/interpretation, Critical revision of article, Approval of article.

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Correspondence to Shivashankar Damodaran.

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Deidentified data from UNOS/OPTN registry, not applicable.

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Deidentified data from UNOS/OPTN registry, not applicable.

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Damodaran, S., Bullock, B., Ekwenna, O. et al. Risk factors for delayed graft function and their impact on graft outcomes in live donor kidney transplantation. Int Urol Nephrol 53, 439–446 (2021). https://doi.org/10.1007/s11255-020-02687-5

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  • DOI: https://doi.org/10.1007/s11255-020-02687-5

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