Background: Numerous risk factors for delayed graft function (DGF) after kidney transplantation (KTx) have been identified. However the effect of DGF as an independent risk factor on transplant outcomes such as renal function or rejection is less clear. DGF is a result of a complex interplay of oxidative stress, immunologic and non-immunologic responses in the allograft. It is known that these signals trigger tissue responses which might result in increased susceptibility for allograft rejection. Acute rejection is associated with decreased renal allograft survival. Therefore, the aim of this study was to examine the association of DGF on acute rejection in the first year after renal transplantation.

Methods: Retrospective single center analysis of 606 (age>18 transplantation date 2008-2014) primary kidney recipients at our institution. Patients with primary non-function were excluded. DGF was defined as dialysis requirement during the first post-operative week. Acute rejection (BPAR) was defined as evidence of acute humoral or cellular rejection according to Banff criteria on a renal biopsy pathology report. Logistic regression models adjusted for multiple potential confounders were used to examine the relationship of DGF and acute rejection in the first year. Since cold ischemia and warm ischemia are in the causal pathway for DGF, they were not included into the model.

Results: One-year follow up was completed for all 606 participants. 126 (20.6%) patients suffered from DGF. Patients with DGF were significantly older, significantly more often of male sex, had higher HLA mismatches, and had higher donor creatinine levels. Donor age, gender, BMI or recipient BMI or recipient PRA-levels were not different in the DGF group vs. the non-DGF group. 129 (20.6%) patients suffered from BPAR within the first year. Adjusted for multiple confounders DGF (OR 1.79, 95% CI 1.08 – 2.94), number of HLA mismatches (OR 1.69. 95% CI 1.23 – 2.31) and PRA (OR 1.6 95% CI 1.14 – 2.06) were independent risk factors for BPAR.

Conclusion: In our cohort, DGF is independently associated with BPAR in the first year after renal transplantation. Thus, presence of DGF should prompt clinicians to consider that those patients belong to a higher immunological risk category.

CITATION INFORMATION: Dienemann T, Weber S, Jacobi J, Eckardt K.-U, Weidemann A. Delayed Graft Function Is an Independent Risk Factor for Renal Allograft Rejection. Am J Transplant. 2016;16 (suppl 3).

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