Delayed Graft Function Adversely Affects Long-Term Survival for Kidney Recipients after Non-Renal Solid-Organ Transplantation
Surgery, University of Wisconsin, Madison, WI
Meeting: 2020 American Transplant Congress
Abstract number: C-067
Keywords: Graft survival, Post-operative complications, Renal failure, Renal function
Session Information
Session Name: Poster Session C: Kidney Complications: Non-Immune Mediated Late Graft Failure
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: End-stage renal disease (ESRD) frequently develops after nonrenal solid-organ transplantation, increasing the number of patients with a prior heart, liver or lung transplant on the kidney transplant waiting list. The impact of delayed graft function (DGF) in kidney after solid-organ transplantation (KASOT) is unknown. This study details survival outcomes associated with DGF in KASOT and defines modifiable risk factors with the aim to prevent development of DGF.
*Methods: The SRTR database was queried for adult recipients who underwent kidney after heart (KAHT), liver (KALiT) and lung transplantation (KALuT) from 2000 to 2017. We compared patient and death-censored graft survival using Kaplan-Meier analysis, and determined the risk factors for DGF with multivariate logistic regression.
*Results: There were 1972 KASOT recipients (29% KAHT, 65% KALiT, 6% KALuT) during the study period, 21% of which developed DGF. DGF reduced patient survival in KAHT (p<0.01) and KALiT (p=0.02), but not KALuT (p=0.49)(please refer to Table 1). Similarly, DGF reduced graft survival in KAHT, KALiT and KALuT when compared to non-DGF KAHT (p<0.01), KALiT (p<0.01) and KALuT (p<0.01), respectively. Major risk factors associated with DGF include donor cause of death (COD), donation after circulatory death (DCD), terminal serum creatinine, and years on dialysis (Table 2 and Table 3). KAHT recipients were more likely to develop DGF, and cold machine perfusion reduced the risk of DGF.
*Conclusions: : DGF negatively affects patient and graft survival in KASOT. Reduction of time on dialysis, selection of suitable donor-recipient pairs and cold machine perfusion could help minimize the risk of DGF, and improve both patient and graft survival.
| KAHT | KALiT | KALuT | ||||
| Years after KASOT | Patient Survival (DGF- vs. DGF+) | Graft Survival (DGF- vs. DGF+) | Patient Survival (DGF- vs. DGF+) | Graft Survival (DGF- vs. DGF+) | Patient Survival (DGF- vs. DGF+) | Graft Survival (DGF- vs. DGF+) |
| 1 | 93 vs. 85 | 96 vs. 82 | 94 vs. 89 | 98 vs. 90 | 94 vs. 93 | 99 vs. 79 |
| 5 | 72 vs. 56 | 88 vs. 70 | 74 vs. 66 | 89 vs. 79 | 68 vs. 93 | 94 vs. 70 |
| 10 | 45 vs. 32 | 76 vs. 51 | 46 vs. 39 | 80 vs. 69 | 36 vs. 31 | 84 vs. 35 |
| P-value | <0.01 | <0.01 | 0.02 | <0.01 | 0.49 | <0.01 |
| Non-DGF (-) % survival vs. DGF(+) % survival; KAHT (n=570), KALiT (n=1278), KALuT (n=124). | ||||||
| Donor Factors | Odds Ratio | 95% Confidence Interval |
| Age, years* | 1.01 | 1.00, 1.03 |
| COD: Anoxia† | 1.45 | 1.04, 2.00 |
| COD: Cerebrovascular† | 1.53 | 1.09, 2.16 |
| Cold ischemia time, hours* | 1.03 | 1.01, 1.04 |
| Cold machine perfusion | 0.67 | 0.50, 0.91 |
| DCD | 3.06 | 1.72, 5.47 |
| Terminal creatinine, mg/dL* | 1.49 | 1.27, 1.74 |
| Recipient Factors | Odds Ratio | 95% Confidence Interval |
| Weight, kg* | 1.02 | 1.01, 1.03 |
| Years on dialysis* | 1.25 | 1.16, 1.34 |
| KAHT (reference: KALiT) | 1.61 | 1.19, 2.16 |
| Footnotes for Table 2 and Table 3: All p-values≤0.01; *, per 1 unit increase; †, COD reference: head trauma (OR=1) | ||
To cite this abstract in AMA style:
Reyes JA, Blanton C, Eerhart M, Leverson G, Chlebeck P, Yankol Y, Fernandez L. Delayed Graft Function Adversely Affects Long-Term Survival for Kidney Recipients after Non-Renal Solid-Organ Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/delayed-graft-function-adversely-affects-long-term-survival-for-kidney-recipients-after-non-renal-solid-organ-transplantation/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress