Impact of delayed graft function on clinical outcomes in highly sensitized patients after deceased-donor kidney transplantation

Seong Gyu Kim; Suyeon Hong; Hanbi Lee; Sang Hun Eum; Young Soo Kim; Kyubok Jin; Seungyeop Han; Chul Woo Yang; Woo Yeong Park; Byung Ha Chung

doi:10.4285/kjt.21.0014

Impact of delayed graft function on clinical outcomes in highly sensitized patients after deceased-donor kidney transplantation

Korean J Transplant. 2021 Sep 30;35(3):149-160. doi: 10.4285/kjt.21.0014.

Authors

Seong Gyu Kim¹, Suyeon Hong^{2

3}, Hanbi Lee^{2

3}, Sang Hun Eum^{2

3}, Young Soo Kim⁴, Kyubok Jin⁵, Seungyeop Han⁵, Chul Woo Yang^{2

3}, Woo Yeong Park⁵, Byung Ha Chung^{2

3}

Affiliations

¹ Division of Nephrology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
² Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
³ Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
⁴ Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.
⁵ Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Abstract

Background: We investigated whether the development of delayed graft function (DGF) in pre-sensitized patients affects the clinical outcomes after deceased-donor kidney transplantation (DDKT).

Methods: The study included 709 kidney transplant recipients (KTRs) from three transplant centers. We divided KTRs into four subgroups (highly sensitized DGF, highly sensitized non-DGF, low-sensitized DGF, and low-sensitized non-DGF) according to panel reactive antibody level of 50%, or DGF development. We compared post-transplant clinical outcomes among the four subgroups.

Results: Incidence of biopsy-proven acute rejection (BPAR) was higher in two highly sensitized subgroups than in low-sensitized subgroups. It tended to be higher in highly sensitized DGF subgroups than in the highly sensitized non-DGF subgroups. In addition, the highly sensitized DGF subgroup showed the highest risk for BPAR (hazard ratio, 3.051; P=0.005) and independently predicted BPAR. Allograft function was lower in the two DGF subgroups than in the non-DGF subgroup until one month after transplantation, but thereafter it was similar. Death-censored graft loss rates and patient mortality tended to be low when DGF developed, but it did not reach statistical significance.

Conclusions: DGF development in highly sensitized patients increases the risk for BPAR in DDKT compared with patients without DGF, suggesting the need for strict monitoring and management of such cases.

Keywords: Acute rejection; Delayed graft function; Graft loss; Kidney transplantation; Sensitization.