Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: a multicenter study

Abstract

This retrospective multicenter (n = 18) cohort study evaluated the incidence, risk factors, and the impact of delayed graft function (DGF) on 1year kidney transplant (KT) outcomes. Of 3992 deceased donor KT performed in 2014-2015, the incidence of DGF was 54%, ranging from 29.9% to 87.7% among centers. Risk factors ( lower-bound-95%CI OR upper-bound-95% CI ) were male gender ( 1.066 1.249 1.463 ), diabetic kidney disease ( 1.053 1.296 1.595 ), time on dialysis ( 1.005 1.007 1.009 ), retransplantation ( 1.035 1.397 1.885 ), preformed anti-HLA antibodies ( 1.011 1.383 1.892 ), HLA mismatches ( 1.006 1.066 1.130 ), donor age ( 1.011 1.017 1.023 ), donor final serum creatinine (sCr) ( 1.239 1.317 1.399 ), cold ischemia time (CIT) ( 1.031 1.043 1.056), machine perfusion ( 0.401 0.542 0.733 ), and induction therapy with rabbit antithymocyte globulin (rATG) ( 0.658 0.800 0.973 ). Duration of DGF > 4 days was associated with inferior renal function and DGF > 14 days with the higher incidences of acute rejection, graft loss, and death. In conclusion, the incidence and duration of DGF were high and associated with inferior graft outcomes. While late referral and poor donor maintenance account for the high overall incidence of DGF, variability in donor and recipient selection, organ preservation method, and type of induction agent may account for the wide variation observed among transplant centers.

Delayed Graft Function Under the Microscope: Surveillance Biopsies in Kidney Transplantation

“…Two-thirds of the recipients in the present study developed DGF by the definition adopted in the present study. This frequency is similar to the one found in the Brazilian multicenter study ( 7 ) and to previous monocentric Brazilian studies ( 8 , 9 ) but is much higher than that reported in other national registries ( 28 , 29 ). Importantly, we observed a high incidence of acute rejection and borderline findings in the surveillance biopsies, which is in line with previous reports ( 8 , 9 ).…”

“…It varies from around one-fourth to approximately two-thirds of kidney transplants from brain-dead deceased donors ( 26 – 29 ). In Brazil, for reasons that are not entirely understood, the reported incidence of DGF is consistently higher compared to other registries ( 7 - 9 ). In a recently published large Brazilian multicenter study, we found a high incidence of DGF and concluded that late referral and poor donor maintenance account for the high overall incidence while variability in donor and recipient selection, organ preservation method, and type of antibody induction may account for the wide variation observed among centers ( 7 ).…”

“…Delayed graft function is currently most frequently characterized by the need for dialysis within the first week after transplantation ( 6 ). It occurs in approximately one-fourth of kidney transplants in Europe and North America but in Brazil, its incidence is much higher ( 7 - 9 ). The increasing age of the deceased donors, the use of organs from expanded criteria donors (ECD), or with high kidney donor profile index (KDPI), which are usually allocated to older recipients, may contribute to increasing its incidence ( 10 , 11 ).…”

Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients

“…These variables included recipient age, donor age, mean TAC levels (considering five TAC levels before the protocol biopsy), induction therapy (basiliximab vs. thymoglobulin), expanded criteria donor, delayed graft function, defined as the need for dialysis in the first week post-transplantation, cold ischemia time, and transfusions prior to KT. These clinical variables have been related to acute graft inflammation [ 27 , 28 , 29 , 30 , 31 ]. The Hosmer–Lemeshow goodness of fit was the principal criterion for selection of the final models.…”

Global Perspective on Kidney Transplantation: Brazil

“…Between 54 and 71% of recipients of deceased donor kidney transplants develop delayed graft function (DGF). This high incidence is a consequence of relatively late donor referral, inadequate donor maintenance and long cold ischemia times (5).…”