Association of Delayed Graft Function with Mortality Post-kidney Transplantation

N. Eguchi¹, H. Ichii², F. J. Ferrey¹, U. G. Reddy¹, D. C. Dafoe², H. Seo³, K. Kalantar-Zadeh¹, E. Tantisattamo¹

¹Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine, Orange, CA, ²Division of Kidney and Pancreas Transplantation, Department of Surgery, University of California Irvine, Orange, CA, ³School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, Irvine, CA

Meeting: 2021 American Transplant Congress

Abstract number: 895

Keywords: Graft failure, Kidney, Kidney transplantation, Mortality

Topic: Clinical Science » Kidney » Kidney: Cardiovascular and Metabolic Complications

Session Information

Session Name: Kidney: Cardiovascular and Metabolic Complications

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Given the ongoing shortage of donated organs, marginal kidneys with a higher possibility of delayed graft function(DGF) have been increasingly utilized. While DGF in kidney transplant recipients(KTR) is associated with acute kidney allograft rejection, its association with mortality is unclear.

*Methods: A single-center retrospective cohort study of consecutive KTR was conducted over 2 years. DGF was defined as a dialysis requirement within 7 days post-transplant. With the study population divided into DGF and non-DGF groups, an association between DGF and all-cause mortality were examined by multiple Cox proportional hazard regression analysis. Competing risk analysis was performed to determine the association of DGF with acute rejection by using mortality as a competing risk variable.

*Results: Of all 219 KTR, mean age±SD was 50±13 years and 123 patients (56%) were male. The majority were White(45%) followed by Asian(20%) and Black (2%). Up to 87 patients(40%) had diabetes and 26% had coronary artery disease. During a median follow-up of 22.2 months(0.63, 34.93), incidence rates of all-cause mortality and acute rejection were 0.002 and 0.006 person-months, respectively. Among 10 patients who died during the follow-up period, 6 patients (60%) were in the DGF group (p 0.012); whereas, only 7 out of 26 patients (27%) with acute rejection had DGF (p 0.871). Compared to the non-DGF group, the DGF group had 4.4 times greater mortality risk (HR 4.39, p 0.022, 95% CI 1.24, 15.55; Figure 1). After adjusted by age, gender, body mass index, former smoking, presence of pre-transplant diabetes, coronary artery disease, stroke, type of deceased kidney donors, the DGF group still had a significantly higher risk of death (HR 4.39, p 0.034, 95% CI 1.12, 17.22). However, DGF was not associated with acute rejection from unadjusted and adjusted competing risk analyses (HR_unadjusted 1.05, p 0.910, 95% CI 0.44, 2.55 and sub-HR_adjusted 1.35, p 0.515, 95% CI 0.55, 3.30).

*Conclusions: While DGF was an independent risk of mortality post-transplant, it was not associated with acute rejection. Non-immunological factors may play a role in poorer survival in KTR who developed DGF. Mechanism and risk factors of mortality in patients with DGF require further studies.

To cite this abstract in AMA style:

Eguchi N, Ichii H, Ferrey FJ, Reddy UG, Dafoe DC, Seo H, Kalantar-Zadeh K, Tantisattamo E. Association of Delayed Graft Function with Mortality Post-kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/association-of-delayed-graft-function-with-mortality-post-kidney-transplantation/. Accessed May 9, 2025.

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