Several single-center studies suggest that delayed graft function (DGF) is not associated with increased risk of graft loss in recipients of donation after cardiac death (DCD) kidneys, but single-center studies may be vulnerable to Type II error. The goal of our study was to investigate these findings using national registry data powered to address this question.

METHODS: Using SRTR data 2005-2015 on 76,114 adult, first-time, kidney only deceased donor kidney transplant (DDKT) recipients, we studied the association between DGF and death-censored graft failure (DCGF) among recipients of donation after brain death (DBD) and DCD kidneys, using Cox regression and adjusting for recipient characteristics and KDPI.

RESULTS: DGF was higher among DCD recipients than DBD recipients (41.4% vs 23.3%, p<0.001). DCGF was higher in recipients who experienced DGF, both among DBD recipients (cumulative incidence at 10y = 34.0% vs 21.5%) and DCD recipients (30.4% vs 20.1%) (Figure). Among DBD recipients, DGF was associated with 3.9-fold higher risk of DCGF in the first year post-transplant (aHR=_3.57 3.86 _4.18, p<0.001); this association attenuated over time but remained significant at >5y post-transplant (aHR=_1.09 1.21 _1.33, p<0.001). Among DCD recipients, increased risk associated with DGF was slightly attenuated in the first year (aHR=_2.78 3.22 _3.73, p<0.001, interaction p=0.02) but comparable to risk for DBD recipients thereafter (interaction p=0.3).

CONCLUSION: DGF was associated with substantially higher risk of DCGF among recipients of both DBD and DCD kidneys, particularly in the first year post-transplant. DCD organs should not be viewed differently in terms of the impact of DGF.

CITATION INFORMATION: Massie A, Segev D. Delayed Graft Function and Long-Term Graft Survival in DBD and DCD Kidney Recipients. Am J Transplant. 2017;17 (suppl 3).

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