Delayed Graft Function and the Risk for Death with a Functioning Graft

Abstract

Delayed graft function (DGF) associates with an increased risk for graft failure, but its link with death with graft function (DWGF) is unknown. We used the US Renal Data System to assemble a cohort of all first, adult, deceased-donor kidney transplant recipients from January 1, 1998, through December 31, 2004. In total, 11,542 (23%) of 50,246 recipients required at least one dialysis session in the first week after transplantation. Compared with patients without DGF, patients with DGF were significantly more likely to die with a functioning graft (relative hazard 1.83 [95% confidence interval 1.73 to 1.93] and 1.53 [95% CI 1.45 to 1.63] for unadjusted and fully adjusted models, respectively). The risk for DWGF was slightly higher among women with DGF than among men. There was no significant heterogeneity among other subgroups, and the results were robust to sensitivity analyses. Acute rejection within the first year attenuated the DGF-DWGF association. Cardiovascular and infectious deaths were slightly more prevalent in the DGF group, but the relative hazards of cause-specific death were similar between DWGF and deaths during total follow-up. In summary, DGF associates with an increased risk for DWGF; the mechanisms underlying the negative impact of DGF require further study.

Complement as a multifaceted modulator of kidney transplant injury

“…IR rates following transplantation are increasing (2), and kidney graft survival is worse in recipients with significant IR injury (3). Donor-reactive T cells and anti-HLA antibodies are established mediators of transplant injury and must be controlled by appropriate immunosuppression.…”

Effect of High-Dose Erythropoietin on Graft Function after Kidney Transplantation

“…A meta-analysis of 34 studies showed a 41% increase in long-term graft loss and a 38% relative increase in acute rejection in patients who developed DGF after renal transplantation (1). DDK transplant recipients with DGF were more likely to die with a functioning graft than were those without DGF (2). Data from United States scientific registries have shown an increase in the rate of DGF, from 14.7% during 1985-1992 to 23% for the 1998-2004 transplant cohorts (2,3).…”

“…DDK transplant recipients with DGF were more likely to die with a functioning graft than were those without DGF (2). Data from United States scientific registries have shown an increase in the rate of DGF, from 14.7% during 1985-1992 to 23% for the 1998-2004 transplant cohorts (2,3). This increase has been contemporaneous with the use of expanded-criteria donor (ECD) and donation of kidneys after cardiac death.…”

Renal Ischemia-Reperfusion Injury Amplifies the Humoral Immune Response

“…2,3 The increased risk of rejection is seen with both cadaveric 3 and live donor 4 organs, and also, it is associated with increased recipient mortality. 5,6 Furthermore, long-term survival is worse in DGF kidney grafts, and there is an increasing recognition that ongoing inflammation drives interstitial fibrosis/tubular atrophy (formerly known as chronic allograft nephropathy) [7][8][9] and may limit average duration of transplant survival.…”