The long-term implications of delayed graft function (DGF) remain controversial. Moreover, non-proportional hazards of DGF have been reported in previous studies, which suggested that its impact might not be constant over time since the initial transplantation.

METHODS: We studied DGF (defined as hemodialysis in the first week post-transplant) in 127,251 adult deceased-donor kidney-only transplantation (DDKT) recipients from January 2000 to June 2014, using SRTR data and excluding recipients with primary nonfunction ( graft failure within the first week). We built Cox models with time-varying coefficients for DGF to test the associations between DGF and death-censored graft failure (DCGF) and post-transplant mortality.

RESULTS: DGF occurred in 24.1% of the patients. DGF was associated with a 3.8-fold higher risk of DCGF at the end of the first month post-KT (p<0.001), which attenuated to a 2.3-fold increase by the end of the sixth month (p<0.001) and became insignificant by the tenth year post-KT (aHR:0.96, p=0.19) (Figure A). Likewise, DGF was associated with a 2.1-fold higher risk of mortality at the end of the first month post-KT (p<0.001), which attenuated to a 1.7-fold increase by the end of the sixth month (p<0.001) and remained significant by the end of the tenth year post-KT (aHR:1.17, p<0.001) (Figure B). The attenuation of DGF-associated risk over time was statistically significant (p<0.001 for both DCGF and mortality).

CONCLUSIONS: DGF was associated with increased risk of DCGF and mortality immediately after DDKT, which attenuated over time. The dynamic change in the magnitude of DGF-associated risk warrants special attention to the early post-transplant management in patients with DGF, and motivates the selection of patients who might better tolerate the physiologic insult of DGF.

CITATION INFORMATION: Liao C, Massie A, Bae S, Muzaale A, Segev D. Dynamics of Delayed Graft Function-Associated Risk in Deceased Donor Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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