The Effect of Delayed Graft Function on Early versus Late Mortality Following Kidney Transplantation

W. Irish¹, Y. Fu², D. B. Leeser¹, K. V. Ravindra³, C. Haisch¹, J. Tuttle¹

¹Surgery, East Carolina University, Greenville, NC, ²Mathematics, East Carolina University, Greenville, NC, ³Surgery, Duke University, Durham, NC

Meeting: 2021 American Transplant Congress

Abstract number: 176

Keywords: Kidney transplantation, Mortality, Renal function, Survival

Topic: Clinical Science » Kidney » Kidney Complications: Non-Immune Mediated Late Graft Failure

Session Information

Session Name: Kidney Complications

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 6, 2021

Session Time: 6:00pm-7:00pm

Presentation Time: 6:15pm-6:20pm

Location: Virtual

*Purpose: Delayed graft function (DGF) is associated with increased risk of long-term graft survival but it’s impact on patient survival has not been studied. Using data from the Organ Procurement and Transplantation Network (OPTN) database, we evaluated the effect of DGF on early versus late mortality following kidney transplantation (KTx).

*Methods: Data on adult (age ≥ 18 years), solitary, primary, deceased donor KTx (2005-2015) were obtained from the OPTN. Pediatric recipients, and recipients of previous KTx or multi-organ transplants were excluded. DGF was defined as the need for dialysis within the first seven days post-transplant. Time-dependent Cox’s hazard model was used to evaluate the effect of DGF on early versus late risk of mortality following KTx. Early mortality was defined as death within the first-year post-KTx. Hazard ratio (HR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. Results are adjusted for donor age, kidney donor profile index, donation after cardiac death, recipient age, sex, race, and history of diabetes, and transplant year.

*Results: 95,271 patients were eligible for study (mean age (SD) = 53.5 (13.0) years, 60.6% were male and 33.3% were Black). Of these, 25.8% had DGF. The prevalence of DGF ranged from 24.4% in 2005 to 29.9% in 2015. Median follow-up was 7 years. Of the 95,271 patients, 27.0% died (33.5% with DGF versus 24.7% without DGF). One-, 5- and 10-year patient survival was 93.1%, 75.9% and 47.3% with DGF, respectively, versus 96.9%, 85.1% and 62.0% without DGF (log-rank p<0.0001). For early mortality, the adjusted HR for DGF versus No DGF was 2.02 (95% CI=1.89, 2.15). For mortality after 1-year post-KTx, the adjusted HR for DGF versus No DGF was 1.42 (95% CI=1.37, 1.46). Further breakdown of the time-dependent effect of DGF on the risk of mortality is provided in Table 1.

*Conclusions: DGF has a significant impact on mortality. The effect of DGF on mortality is more pronounced in the first-year post-KTx, but is still impactful even after 5-years post-KTx.

Table 1: Time-dependent Effect of DGF on Risk of Mortality Following Kidney Transplantation
Time-dependent Risk	Adjusted Hazard Ratio for DGF versus No DGF (95% CI)
<= 1 year	2.20 (1.89, 2.15)
Between 1 and 2 years	1.50 (1.37, 1.63)
Between 2 and 3 years	1.39 (1.27, 1.51)
Between 3 and 4 years	1.51 (1.40, 1.64)
Between 4 and 5 years	1.40 (1.29, 1.52)
> 5 years	1.39 (1.33, 1.45)

To cite this abstract in AMA style:

Irish W, Fu Y, Leeser DB, Ravindra KV, Haisch C, Tuttle J. The Effect of Delayed Graft Function on Early versus Late Mortality Following Kidney Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-effect-of-delayed-graft-function-on-early-versus-late-mortality-following-kidney-transplantation/. Accessed May 12, 2025.

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