Is “Death with a Functioning Graft (DWF)” Really Death with Function? Data from the Long-Term Deterioration of Kidney Allograft Function (DeKAF) Study.
1UAB, Birmingham, AL
2U Minnesota, Minneapolis, MN
3U Iowa, Iowa City, IA
4U Manitoba, Winnipeg, Canada
Meeting: 2017 American Transplant Congress
Abstract number: 267
Keywords: Glomerular filtration rate (GFR), Graft failure, Graft function, Kidney transplantation
Session Information
Session Name: Concurrent Session: Long Term Kidney Graft Survival I
Session Type: Concurrent Session
Date: Monday, May 1, 2017
Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: E450a
To understand causes of kidney transplant (KT) failure, outcomes are often segregated into death-censored graft failure (DCGF, a proxy for immunologic injury) and DWF. To define whether these categories actually represent distinct entities, we examined clinical course and the change in kidney function (slope of 1/Cr) from 3-months post-transplant (baseline) among 3719 DeKAF study participants from seven centers followed prospectively from transplant (2005-11) for a median of 5.4 years. 3 groups were defined by outcome event: death (DWF), graft failure (DCGF), or neither (maintained function, MF).
| DWF | DCGF | MF | P | |
| N | 360 | 312 | 3047 | <0.001 |
| Age at KT, mean (SD) | 56.8 (12.4) | 42.2 (14.7) | 48.9 (14.7) | <0.001 |
| Race (% African American) | 20.6 | 31.8 | 15.8 | <0.001 |
| Yrs on dialysis, median (IQR) | 2.1 (0.4, 4.9) | 1.6 (0.3, 4.8) | 1.0 (0,3.0) | <0.001 |
| Delayed graft function (%) | 14.3 | 15.1 | 6.6 | <0.001 |
| AR before month 3 (%) | 7.8 | 15.4 | 6.7 | <0.001 |
| Yrs to event (after month 3), mean (SD) | 3.3 (2.0) | 3.0 (1.8) | NA | 0.14 |
| Baseline serum Cr, mean (SD) | 1.4 (0.5) | 1.7 (0.8) | 1.4 (0.4) | <0.001 |
| Slope* (dL/mg/yr) | -0.018 | -0.097 | -0.005 | <0.001 |
*From a random effects model with fixed effects for event type, time, and their interaction and random intercept with compound symmetry correlation structure. Excluding serum Cr values within 2 weeks of graft failure did not qualitatively change findings.
Patients with DCGF were younger at KT, more likely AA, and more likely to have had early AR, demonstrating a significantly greater slope of decline in 1/Cr before DCGF than DWF or MF (-0.097 vs -0.018 or -0.005). Those with DWF were older at KT and had lengthier time on dialysis, but similar incidence of early AR, baseline renal function, and slope beyond day 90 as those with MF. DWF and DCGF represent two distinct adverse outcomes after KT, and patients with DWF maintain stable graft function, comparable to those with excellent outcomes, prior to terminal event.
CITATION INFORMATION: Gaston R, Fieberg A, Hunsicker L, Rush D, Leduc R, Connett J, Matas A, DeKaf Investigators Is “Death with a Functioning Graft (DWF)” Really Death with Function? Data from the Long-Term Deterioration of Kidney Allograft Function (DeKAF) Study. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Gaston R, Fieberg A, Hunsicker L, Rush D, Leduc R, Connett J, Matas A, Investigators DeKaf. Is “Death with a Functioning Graft (DWF)” Really Death with Function? Data from the Long-Term Deterioration of Kidney Allograft Function (DeKAF) Study. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/is-death-with-a-functioning-graft-dwf-really-death-with-function-data-from-the-long-term-deterioration-of-kidney-allograft-function-dekaf-study/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress