Delayed graft function (DGF) is a common complication of kidney transplantation related with both donor and recipient. Through a donor-paired kidney analysis we aimed to understand recipient risk factors for DGF and its importance in long-term graft outcome.
Retrospective cohort study using our center database of kidney graft (KG) recipients from 1983-2010. We identified 473 pairs of adult kidney-only transplants that were procured from the same adult donor, and selected for analysis those with discordant occurrence of DGF (n= 156 pairs). Predictors of DGF were analyzed by a logistic regression model (RM) (variables with p-value < 0.1 in the univariate analysis: recipient gender and age, dialysis vintage, hepatitis C and body mass index (BMI). Graft survival was calculated by the Kaplan-Meier method. Risk factors for graft failure were explored through a Cox RM (variables with p-value < 0.1 in the univariate analysis: recipient gender and age, number of HLA mismatches, DGF, acute rejection, dialysis vintage). Donors (n=156) had a median age of 32.5 yrs and 72.4% were males.
|Age in yrs, mean||40.7||40.2||41.1||0.475|
|BMI in Kg/m2 , mean||22.6||21.8||23.4||<0.001|
|Dialysis vintage in yrs, median||3.3||2.6||3.8||0.001|
|Hepatitis C+, %||21.6||18.6||24.7||0.193|
|Total HLA mismatches, mean||3.3||3.3||3.4||0.165|
|Cold ischemia >24hours, %||44.4||41.1||47.8||0.293|
|Acute rejection, %||27.2||23.7%||30.8%||0.162|
|Creatinine at 1-yr in mg/dl, median||1.4||1.4||1.5||0.011|
|Patients follow-up in yrs, mean||11.8||12.8||10.7||0.006|
DGF was independently predicted by male recipient gender (OR=1.82, p=0.037), BMI (OR=1.20 per each 1Kg/m2 increase, p<0.001) and dialysis vintage (reference 0-2 yrs: OR=2.36 for 2-4 yrs, OR=2.76 for 4-6 yrs, OR=2.20 for >6 yrs; p=0.035). A significant association between DGF and a reduction in overall (89% and 74% in patients without DGF and 72% and 55% in those with DGF at 5 and 10-yrs; log-rank p<0.001) and death-censured (90% and 81% in patients without DGF and 83% and 71% in those with DGF at 5 and 10-yrs; log-rank p=0.013) graft survival was detected. DGF was a significant risk factor for death-censured (HR=1.62, p=0.034) and overall (HR=2.11, p<0.001) graft failure in Cox RM analysis.
After fully matching for donor factors, our results show that recipient characteristics as BMI and dialysis vintage should be addressed in order to decrease DGF occurrence and, eventually, to improve KG survival.
To cite this abstract in AMA style:Malheiro J, Aguiar P, Fonseca I, Martins L, Almeida M, Pedroso S, Dias L, Henriques A, Cabrita A. Paired Kidney Analysis of Delayed Graft Function: Recipient Risk Factors for and Role in Graft Survival, A [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/paired-kidney-analysis-of-delayed-graft-function-recipient-risk-factors-for-and-role-in-graft-survival-a/. Accessed May 6, 2021.
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