Delayed graft function (DGF), defined as need for dialysis in 1st week following kidney transplant (KT), is an early surrogate marker of organ quality and preservation. Previous studies have shown that DGF is a risk factor for graft loss. Rates of DGF are related to deceased donor (DD) age and category, being highest in donation after cardiac death (DCD) donors, intermediate in donation after brain death (DBD) expanded criteria donors (DBD/ECD), and lowest in standard criteria donors (DBD/SCD). Methods: To determine the relative influence of DGF on DD subgroup outcomes, we performed a single center retrospective analysis in adult DD KT patients (pts). >85% of adult DCD and DBD/ECD kidneys were placed on machine preservation. All pts received depleting antibody induction with FK/mycophenolate. We also stratified pts receiving dual adult kidneys (DKT) and pediatric en bloc (PEB) KTs and those receiving KTs from DDs with terminal acute kidney injury (AKI, defined as doubling of DD's admit serum creatinine [SCr] and a terminal SCr >2.0 mg/dl). Within each subgroup, we determined death-censored graft survival (DCGS) rates in pts ± DGF. Results: Since 10/01, we performed 1499 DD KTs, including 603 DBD/SCD, 414 DBD/ECD, 261 DCD, 118 AKI, 69 DKT and 34 PEB. DGF rates were 11.8% in PEB, 21.7% in DKT, 23.1% in DBD/SCD, 23.9% in DBD/ECD, 41.5% in AKI, and 57.9% in DCD KT pts. DGF rates were significantly higher in DCD and AKI and significantly lower in PEB KT pts. With a mean follow-up of 64 months, DCGS rates in DBD/SCD (85% vs 64%) and DBD/ECD (71% vs 45%) KTs were significantly lower (p<0.0001) in pts with DGF. However, in the remaining 4 DD subgroups, DCGS rates were not different in pts ± DGF. Conclusions: In pts receiving SCD and ECD kidneys from DBD donors, DGF continues to adversely influence medium-term outcomes. However, in DCD, AKI, DKT, and PEB DD KT pts, the negative effect of DGF on DCGS appears to be mitigated. In DCD and AKI DD KT, the mechanism of DGF may be related to terminal (and presumably reversible) warm ischemia whereas in DKT and PEB DD KT, implanting 2 kidneys may both reduce DGF and moderate its effects.

CITATION INFORMATION: Khan M, El-Hennawy H, Farney A, Rogers J, Orlando G, Reeves-Daniel A, Palanisamy A, Gautreaux M, Iskandar S, Doares W, Kaczmorski S, Stratta R. Differential Effect of Delayed Graft Function (DGF) on Kidney Transplant Outcomes: When Does DGF Not Make a Difference? Am J Transplant. 2016;16 (suppl 3).

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