Delayed graft function is not associated with an increased incidence of renal allograft rejection

Abstract

Delayed graft function (DGF) is considered as a risk factor for renal allograft rejection, but this association might be confounded by diagnostic biases (e.g., higher biopsy frequency in patients with DGF, inclusion of clinically diagnosed rejection episodes, and limited details on the rejection phenotype). This retrospective study including 329 deceased donor transplantations aimed to clarify a causal relationship between DGF and rejection. DGF occurred in 93/329 recipients (28%), whereas immediate graft function (IGF) in 236/329 recipients (72%). The percentage of patients with ≥1 allograft biopsy within the first year post-transplant was similar between the DGF and IGF group (96% vs. 94%; p=0.60). The cumulative one-yr incidence of biopsy-proven clinical (35% vs. 34%; p=0.62) and combined (sub)clinical rejection (58% vs. 60%; p=0.79) was not different between the two groups. Furthermore, there were no differences regarding rejection phenotypes/severities and time frame of occurrence. By multivariable Cox regression analysis, donor-specific HLA antibodies, younger recipient age, and immunosuppressive regimens were independent predictors for clinical rejection, while DGF was not. These results in an intermediate sized, but thoroughly investigated patient population challenge the concept that DGF is a risk factor for rejection and highlights the need for additional studies in this regard.

Effects of Delayed Graft Function on Transplant Outcomes: A Meta-analysis

“… 2 - 4 , 7 , 15 , 18 , 37 , 44 , 45 Eight studies included living-donor (LD) kidney transplants, 2 , 5 , 32 , 35 , 36 , 43 - 45 and 3 of these studies were restricted to LD transplants only. 36 , 44 , 45 For the rest of the studies, 7 studies included DBD kidneys only, 10 , 18 , 25 , 29 , 31 , 37 , 40 4 studies included DCD kidneys only, 3 , 19 , 30 , 46 whereas 5 studies included both DBD and DCD kidneys, 4 , 7 , 21 , 39 , 42 and 13 studies stated they included DD kidneys without specifying whether it was DBD or DCD. 6 , 8 , 11 , 14 , 15 , 24 , 26 - 28 , 33 , 34 , 41 , 45 One paper included in the review did not specify if donors were LD or DD.…”

“…Of the 38 studies identified, 30 were single-center studies, [2][3][4][5][6][7]13,14,18,19,21,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and 8 studies were registry-based studies. 8,10,11,15,[43][44][45][46] Registries included the United States Renal Data System, Scientific Registry of Transplant Recipients, United Network for Organ Sharing, Thai Transplant Registry, the Australia and New Zealand Dialysis and Transplant Registry, NHS Blood and Transplant, and Iran, Kingdom of Saudi Arabia & Kuwait Registry were used by the studies included in our meta-analysis.…”

“…Of the 38 studies included in our analysis, 29 (76%) studies investigated graft failure outcomes comparing patients who experienced DGF to those who did not experience DGF after transplantation. Of the 29 studies that examined graft failure, 23 studies were single-center studies 2,3,[5][6][7]13,14,18,19,21,24,[27][28][29][30][31][32][33][34][35][36]38,39 and 6 studies were registry-based studies. 8,10,11,15,43,44 Figure 2 shows a forest plot summarizing effects of DGF on graft failure at 1-, 3-, and 5-y posttransplant, stratified by center level studies and registry-based studies when applicable.…”

“…Of the 38 studies, 22 (58%) of them reported the incidence of acute rejection among patients with DGF and those without DGF, including 19 single-center studies, [3][4][5][6][7]19,21,25,[27][28][29][30]32,33,[37][38][39]41,42 and 3 registry-based studies. 15,45,46 In single-center studies, DGF was associated with a significantly higher odds of an acute rejection episode compared with patients who did not experience DGF within 1-y post transplant (OR 1.84; 95% CI, 1.30-2.61; P < 0.01) and at 3-y posttransplant (OR 2.05; 95% CI, 1.41-2.98; P < 0.01).…”

Body mass index: short- and long-term impact on kidney transplantation

“…According to the literature, there is a tight relationship between specific immunity and DGF. Many authors have found an association between initial graft dysfunction and higher incidence of rejection crisis .…”