Risk factors and outcomes of prolonged recovery from delayed graft function after deceased kidney transplantation

Ren Fail. 2020 Nov;42(1):792-798. doi: 10.1080/0886022X.2020.1803084.

Abstract

Objective: We aimed to evaluate the effect of prolonged recovery from DGF on outcomes, using a new definition of DGF recovery time, among deceased donor kidney transplant recipients with DGF, and to examine the risk factors for prolonged recovery.

Methods: From 2007 to 2016, 91 deceased donor kidney transplant recipients with DGF were retrospectively analyzed. DGF recovery time was defined as the time from transplantation to achieve a stable estimated glomerular filtration rate (eGFR). Recipients with a DGF recovery time greater than or equal to the median were assigned to the prolonged recovery group, while the others were assigned to the rapid recovery group.

Result: The median DGF recovery time was 27 days. Donor terminal eGFR was significantly lower in the prolonged recovery group (n = 46) compared with the rapid recovery group (n = 45) (median 24.9 vs. 65.4 ml/min/1.73m2, p = 0.004). The eGFR at 1 year post-transplant in the prolonged recovery group was significantly lower than that in the rapid recovery group (50.6 ± 20.0 vs. 63.5 ± 21.4 ml/min/1.73m2, p = 0.005). The risk of adverse outcomes (acute rejection, pneumonia, graft failure, and death) was significantly greater in the prolonged recovery group (hazard ratio 2.604, 95% confidence interval 1.102-6.150, p = 0.029) compared with the rapid recovery group.

Conclusion: Decreased donor terminal eGFR is a risk factor for prolonged recovery from DGF after deceased kidney transplantation. Prolonged DGF recovery time is associated with reduced graft function at 1-year post-transplant, and poor transplant outcome.

Keywords: Kidney transplantation; acute kidney injury; delayed graft function; graft survival.

MeSH terms

  • Adult
  • Delayed Graft Function / etiology*
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection
  • Graft Survival
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / methods*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tissue Donors*

Grants and funding

This project was supported by the National Natural Science Foundation of China [81870511, 81670680, 81700655], Science and Technology Planning Project of Guangdong Province, China [2014B020212006, 2015B020226002, 2017A020215012], Guangdong Natural Science Foundation [2018A030313016, 2018A030313855, 2015A030313135], Key Scientific and Technological Program of Guangzhou City [201803040011, 201903010058], Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology [2013A061401007, 2017B030314018] and Guangdong Provincial International Cooperation Base of Science and Technology [Organ Transplantation, 2015B050501002].