Delayed graft function is correlated with graft loss in recipients of expanded-criteria rather than standard-criteria donor kidneys: a retrospective, multicenter, observation cohort study

Abstract

Background: Although the use of expanded-criteria donors (ECDs) alleviates the problem of organ shortage, it significantly increases the incidence of delayed graft function (DGF). DGF is a common complication after kidney transplantation; however, the effect of DGF on graft loss is uncertain based on the published literature. Hence, the aim of this study was to determine the relationship between DGF and allograft survival. Methods: We conducted a retrospective, multicenter, observation cohort study. A total of 284 deceased donors and 541 recipients between February 2012 and March 2017 were included. We used logistic regression analysis to verify the association between clinical parameters and DGF, and Cox proportional hazards models were applied to quantify the hazard ratios of DGF for kidney graft loss. Results: Among the 284 deceased donors, 65 (22.8%) donors were ECD. Of the 541 recipients, 107 (19.8%) recipients developed DGF, and this rate was higher with ECD kidneys than with standard-criteria donor (SCD) kidneys (29.2% vs. 17.1%; P = 0.003). The 5-year graft survival rate was not significantly different between SCD kidney recipients with and without DGF (95.8% vs. 95.4%; P = 0.580). However, there was a significant difference between ECD kidney recipients with and without DGF (71.4% vs. 97.6%; P = 0.001), and the adjusted hazard ratio (HR) for graft loss for recipients with DGF was 1.885 (95% confidence interval [CI] = 1.305–7.630; P = 0.024). Results showed that induction therapy with anti-thymocyte globulin was protective against DGF (odds ratio = 0.359; 95% CI = 0.197–0.652; P = 0.001) with all donor kidneys and a protective factor for graft survival (HR = 0.308; 95% CI = 0.130–0.728; P = 0.007) with ECD kidneys. Conclusion: DGF is an independent risk factor for graft survival in recipients with ECD kidneys, but not SCD kidneys.

Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation

“…The impact of DGF on graft survival is well established, as shown in a recently published large multicenter study ( 7 ). However, controversy is still out on whether the worst graft survival is restricted only to recipients of kidneys from standard criteria donors ( 31 , 32 ).…”

Donor plasma mitochondrial DNA is associated with antibody-mediated rejection in renal allograft recipients

“…A systematic review showed that recipients with DGF had a 41% increased risk of graft loss [ 20 ]. Our previous study also found that DGF is an independent risk factor for graft survival in recipients with ECD kidneys [ 21 ]. mtDNA levels have been confirmed as a predictive marker of AKI, and correlate with severity of renal dysfunction in chronic kidney injury [ 22 ].…”

Delayed Graft Function and Acute Rejection in Kidney Transplant Patients with Positive Panel-Reactive Antibody and Negative Donor-Specific Antibodies

“…DGF and GR are caused by complex factors with varying severities. However, both DGF and GR seem to be good predictors for long-term outcomes after kidney transplantation, especially deceased donors (25)(26)(27). Ischemia and reperfusion injury are complex pathophysiological phenomena, inevitable in kidney transplantation, and are major mechanisms for DGF after transplantation.…”