Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*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.
|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|
|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|
|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 October 26, 2020.
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