Duration of delayed graft function and outcomes after kidney transplantation from controlled donation after circulatory death donors: a retrospective study

Abstract

Summary The impact of the duration of delayed graft function (DGF) on graft survival is poorly characterized in controlled donation after circulatory death (DCD) donor kidney transplantation. A retrospective analysis was performed on 225 DCD donor kidney transplants between 2011 and 2016. When patients with primary nonfunction were excluded (n = 9), 141 recipients (65%) had DGF, with median (IQR) duration of dialysis dependency of 6 (2–11.75) days. Longer duration of dialysis dependency was associated with lower estimated glomerular filtration rate at 1 year, and a higher rate of acute rejection. On Kaplan–Meier analysis, the presence of DGF was associated with lower graft survival (log‐rank test P = 0.034), though duration of DGF was not (P = 0.723). However, multivariable Cox regression analysis found that only acute rejection was independently associated with lower graft survival [HR (95% CI) 4.302 (1.617–11.450); P = 0.003], whereas the presence of DGF and DGF duration were not. In controlled DCD kidney transplantation, DGF duration itself may not be independently associated with graft survival; rather, it may be that acute rejection associated with prolonged DGF is the poor prognostic factor.

A nationwide evaluation of deceased donor kidney transplantation indicates detrimental consequences of early graft loss

“…1,2 Although 30-day outcomes are generally used as primary outcomes for surgical complications, this time point may not accurately reflect the actual incidence of EGL. DGF may extend beyond 30 days, [14][15][16] and a Figure 2 | Landmark analysis showing the short-term and long-term patient survival rates. Reference population: recipients without early graft loss after the first kidney transplant procedure.…”

Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study

“…The duration of DGF was defined as the number of days between transplantation and the last session of posttransplant dialysis. Recipients with DGF were grouped according to DGF duration (DGF < 7 days; DGF 7–14 days; DGF >14 days) 15 . Sensitivity analyses with other DGF duration thresholds were also undertaken.…”

“…However, it is also important to take into account DGF duration when considering the effects of DGF on longer‐term graft outcomes, as this may better reflect the severity of the underlying acute kidney injury and the organ's ability to recover. Prolonged DGF duration is known to increase the risk of graft loss in recipients of DBD donor kidney transplants 15,18 . However, the influence of DGF duration on longer‐term graft outcomes after DCD donor kidney transplantation has not been specifically examined in a large national analysis 15,18,19 …”

Delayed graft function and perfusion parameters of kidneys from uncontrolled donors after circulatory death

“…More recently, a similar incidence of DGF (65%) was reported in 225 DCD kidney transplants performed between 2011 and 2016 in the United Kingdom. 27 In a large cohort of 517 kidneys transplanted from 288 uDCDs from the Spanish experience 28 DGF was observed in the 65%. Differently from our study, a small percentage of DCDs died from in-hospital cardiac arrest (14/288, 5%) and different techniques for in situ abdominal organ preservation were employed, ranging from cardiac compression alone (1%) to nRP (52%).…”