Background: Delayed graft function (DGF) is defined as the need for dialysis within the first week following kidney transplantation. DGF is a major risk factor for chronic allograft loss. Ischemia time is a primary cause of DGF and current clinical protocols strive to minimize this period; however, other risk factors may exist. In previous work we have shown that viral infection may increase the risk of AV fistula failure presumably through subclinical vascular damage (JASN, 23:266A). On this basis, we theorized that previous viral infection and/or other vasculopathic processes may also translate into a risk factor for DGF.

Methods: All adult, first-time renal transplant cases reported to the USRDS from 1994-2009 were queried for hepatitis C virus (HCV), human immunodeficiency virus (HIV), hemolytic uremic syndrome (HUS), and a history of vasculitis using ICD-9 codes and assessed for the occurrence of DGF. Descriptive statistics and a multivariate analysis using logistic regression were performed.

Results: 232,495 patients were available for analysis. 230,525 had complete data for DGF. Patient demographics for this group included a mean age of 47.3 yrs, 60.3% male, 68.7% Caucasian and 24.0% AA. 65.5% of transplants were from deceased donors. DGF was identified in 40,257 (17.5%) patients. Using multivariate analysis, the odds ratio (OR) and 95% CL of DGF associated with each diagnosis were: HCV (OR: 1.42; 1.33, 1.52), HIV (OR: 1.79; 1.43, 2.24), HUS (OR: 1.25; 1.03, 1.51). Of the other vasculitides, only giant cell arteritis (OR: 2.07; 1.20, 3.56) was significant. Cold ischemia time, donor creatinine levels, and donor type were also significantly associated with DGF.

Conclusion: DGF was identified in 17.5% of kidney transplant patients from the USRDS. After controlling for donor creatinine, cold ischemia time, and donor type- HCV, HIV, HUS and giant cell arteritis were significantly associated with DGF. We would speculate that previous vascular damage associated with viral infection, HUS or arteritis may predispose to DGF following renal transplantation.

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