*Purpose: Delayed kidney graft function (DGF) after SLKT transplant may be associated with increased risk of kidney graft loss, morbidity and mortality. We examined the incidence and predictors of DGF after SLKT in a contemporary large multicenter cohort, and determine its impact on length of stay (LOS) of transplant admission.

*Methods: The US Multicenter SLKT consortium consists of candidate, donor and recipient data on all adult (≥18yrs) recipients of SLKT at 6 large centers in 6 different UNOS regions between Feb 2002 to June 2017. DGF was defined as transient use renal replacement therapy (RRT) within 7 days after SLKT transplant. Multivariable logistic regression was used to identify the predictors of DGF and to understand the impact of DGF on patient outcomes including LOS of transplant admission, kidney graft loss defined as recurrent stage 4-5 CKD and patient survival.

*Results: A total of 570 patients were evaluated, with a median age of 58 years (IQR:51-64), 37% female, 76% Caucasian, 33% hepatitis C, 20% NASH, and 23% had alcohol-related liver disease. Median MELD-Na at SLKT was 28 (IQR 23-34). Only 39% were on RRT at SLKT. One hundred thirty-three (23%) developed DGF requiring RRT during the transplant hospitalization, for a median of 13 days (IQR:4-40) and 25 had early kidney graft loss within first year. Black (OR= 0.332;P=0.012) and White race (OR=0.345;P<0.001) compared to others races (Hispanics, Asians and others), pre-LT RRT (OR=3.94;P<0.001), advanced donor age (OR=1.03 per year; P<0.001) and cold ischemia time(CIT) (OR=1.002 per minute; P=0.018) were independently associated with increased odds of DGF, adjusting for recipient age, sex, etiology of liver disease, type of renal failure, pre-LT hypertension, BMI, diabetes, MELD-Na, renal risk index, immunosuppression and induction. Patients with DGF had a longer mean LOS of transplant admission (37.8±34.9 days vs. 23.9±24.1 days; P<.0001), higher rates of post-SLKT recurrent stage 4-5 CKD (32% vs. 17%; P<0.001). However, long-term overall patient survival was in DGF vs. no-DGF group(64% vs. 68%; P=0.3).

*Conclusions: DGF affected one fourth of SLKT recipients, and is significantly associated with prolonged transplant admission LOS and recurrent stage 4-5 CKD including kidney graft loss. Efforts should be taken to minimize DGF in order to improve long-term renal outcomes after SLKT.

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