Delayed Kidney Graft Function in SPK Recipients Is Associated with Poor Long-Term Outcomes

B. Muth, B. Astor, D. Kaufman, H. Sollinger, R. Hofmann, M. Mohamed, V. Vidyasagar, J. Pirsch, J. Bellingham, J. Odorico, A. Djamali

Department of Medicine, University of Wisconsin, Madison, WI
Department of Surgery, University of Wisconsin, Madison, WI

Meeting: 2013 American Transplant Congress

Abstract number: 393

The association of delayed kidney graft function (DGF) with long-term clinical outcomes in simultaneous pancreas kidney (SPK) transplant recipients is largely unknown. To address this question we examined patient and graft (kidney and pancreas) outcomes in 733 consecutive primary SPK recipients transplanted between 1994-2010 with a median follow-up of 5.1 years. DGF was defined as dialysis within the first week post transplant. There were 58 patients (7%) with DGF (Table 1).

Baseline Characteristics
	DGF (+)	DGF (-)	p
Number of Patients	58	675
Age±SD	40±7	39±7	0.7
Male Gender (%)	28 (48)	425 (63)	0.03
Caucasian Race (%)	52 (990)	638 (95)	0.1
T cell depleting Induction (%)	24 (41)	345 (51)	0.2
Donor Age (%)	33±12	30±13	0.08
DCD (%)	22 (38)	46 (7)	< 0.0001
Pre-emptive Tx	7 (12)	227 (34)	0.001
Pre-Tx time on HD±SD (m)	14±17	7±11	0.0001

DGF was significantly associated with patient death and loss of both grafts (panels A, B, C), rejection of either allograft (panel D), and post transplant cardiovascular (CV) events. Pancreas failure appears to occur early in DGF. Donor age was a significant factor in pancreas failure, death, any graft rejection and CV events. Gender, donation after circulatory death (DCD) and pre-emptive transplant were not associated with poor outcomes.

Cox Regression Analysis
		HR	95% CI	p
Kidney Failure	DGF	1.57	1.01-2.43	0.04
	T Cell Depletion Induction	0.62	0.47-0.82	0.001
Pancreas Failure	DGF	1.67	1.1-2.53	0.02
	T Cell Depletion Induction	0.59	0.45-0.77	<0.0001
	Donor Age	1.03	1.02-1.04	<0.0001
Death	Recipient Age	1.04	1.01-1.06	0.004
	T Cell Depletion Induction	0.51	0.36-0.72	<0.0001
	Donor Age	1.02	1-1.03	0.01
Any Rejection	DGF	1.9	1.29-2.79	0.001
	Recipient Age	0.97	0.95-0.99	<0.0001
	Donor Age	1.02	1-1.04	0.02
Cardiovascular Events	DGF	2.9	1.46-6.01	0.003
	Recipient Age	1.11	1.07-1.16	<0.0001
	Donor Age	1.02	1-1.04	0.03

DGF was associated with worse survival, immunologic and CV outcomes in SPK recipients. Use of T cell depletion induction was associated with decreased mortaliy and graft loss in SPK.

To cite this abstract in AMA style:

Muth B, Astor B, Kaufman D, Sollinger H, Hofmann R, Mohamed M, Vidyasagar V, Pirsch J, Bellingham J, Odorico J, Djamali A. Delayed Kidney Graft Function in SPK Recipients Is Associated with Poor Long-Term Outcomes [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/delayed-kidney-graft-function-in-spk-recipients-is-associated-with-poor-long-term-outcomes/. Accessed November 23, 2024.

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