Risk Factors for Death-Censored Graft Loss and Death in Kidney Transplant Recipients with Delayed Graft Function

Background: Delayed Graft Function (DGF) independently causes a significant reduction in graft survival. Very few studies have analyzed the risk factors for graft loss and death in recipients. Methods: We used the Organ Procurement and Transplantation Network (OPTN) data for solitary kidney transplants from 1/1/2000 to 12/31/2023. We included adults with solitary ABO-compatible kidney transplants who were on dialysis before the transplant. We limited the study population to people who had delayed graft function, defined as requiring dialysis during the first week after transplantation. Our outcomes were death-censored graft loss (DCGL) and death with functioning graft. Multivariable Cox regression was done to evaluate the association of risk factors and adjusted for recipient, donor, and transplant characteristics. Results: There were 72,992 solitary deceased kidney transplants with DCGL 23% and death 20.1%. Risk factors for increased DCGL were younger age (aHR=0.79 95%CI 0.78-0.80), lower donor BMI (aHR=0.94 95%CI 0.93-0.95), African American recipient (aHR=1.25 95%CI 1.20-1.29), and donor (aHR=1.09 95%CI 1.04-1.15), history of smoking ( aHR=1.19 95% CI 1.15-1.23), and extended criteria donor (aHR=1.25; 95% CI 1.19-132) (Fig 1A) Risk factors for increased risk for death with functional graft were higher recipient age ( aHR=1.56 95% CI 1.54–1.59), recipient gender male (aHR=1.06 95% CI 1.02-1.10), higher recipient BMI (aHR=1.03 95% CI 1.01–1.04), history of smoking (aHR=1.16 95% CI 1.12-1.21), and ECD (aHR=1.14 95% CI (1.07–1.20) (Fig 1B) Conclusion: Recipients of DGF have unique risk factors for DCGL and death, emphasizing the need for closer follow-up and monitoring of this group. Additional prospective studies are essential for patient and graft survival.