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

Abstract

Delayed graft function (DGF) is a frequent complication of kidney transplantation, but its impact on long- and short-term transplant outcomes is unclear. We conducted a systematic literature search for studies published from 2007 to 2020 investigating the association between DGF and posttransplant outcomes. Forest plots stratified between center studies and registry studies were created with pooled odds ratios. Posttransplant outcomes including graft failure, acute rejection, patient mortality, and kidney function were analyzed. Of the 3422 articles reviewed, 38 papers were included in this meta-analysis. In single-center studies, patients who experienced DGF had increased graft failure (odds ratio [OR] 3.38; 95% confidence interval [CI], 1.85-6.17; P < 0.01), acute allograft rejection (OR 1.84; 95% CI, 1.30-2.61; P < 0.01), and mortality (OR 2.32; 95% CI, 1.53-3.50; P < 0.01) at 1-y posttransplant. Registry studies showed increased graft failure (OR 3.66; 95% CI, 3.04-4.40; P < 0.01) and acute rejection (OR 3.24; 95% CI, 1.88-5.59; P < 0.01) but not mortality (OR 2.27; 95% CI, 0.97-5.34; P = 0.06) at 1-y posttransplant. DGF was associated with increased odds of graft failure, acute rejection, and mortality. These results in this meta-analysis could help inform the selection process, treatment, and monitoring of transplanted kidneys at high risk of DGF.

Kidney Survival Impact of Delayed Graft Function Depends on Kidney Donor Risk Index: A Single-Center Cohort Study

“…Delayed graft function has been identified as a crucial prognostic factor for graft survival [2,6]. It is caused by damage resulting from the ischemia-reperfusion process, which is particularly significant in recipients of grafts from expanded criteria donors and donation after circulatory death [1].…”

“…contrast, two meta-analyses have demonstrated that DGF constitutes a risk factor for graft loss [2,6].…”

“…However, the medium and long-term negative effects of DGF are not well defined, and there are contradictory findings regarding graft survival in individual studies [2]. In contrast, two meta-analyses have demonstrated that DGF constitutes a risk factor for graft loss [2,6].…”

“…The lower long-term survival in kidneys with DGF has been associated with the damage caused by ischemia reperfusion, which can lead to cell death, inflammation, and fibrosis [1,7]. Likewise, DGF has been linked to being a risk factor for graft rejection and, therefore, it can affect both patient and graft survival [2,6]. It has been theorized that delayed graft function may lead to graft fibrosis progression, but the results in this regard are contradictory [8].…”

Identification of potential necroinflammation-associated necroptosis-related biomarkers for delayed graft function and renal allograft failure: a machine learning-based exploration in the framework of predictive, preventive, and personalized medicine

“…Particularly in recent years, as the proportion of donation after cardiac-death (DCD) donors has increased [ 9 ], the DGF rate has increased from 24.4 to 42.5% compared to KTx with donation after brain-death (DBD) donors [ 10 ]. The worse outcome relevance of KTx patients who have experienced DGF is mainly reflected in renal dysfunction, graft loss, rejection, and mortality [ 11 , 12 ]. Therefore, early prediction and targeted intervention are especially important.…”