Delayed Graft Function among Simultaneous Pancreas-Kidney Transplant Recipients Is Associated with an Increased Risk of Urinary Tract Infections and Kidney Rejections

Background: Kidney delayed graft function (K-DGF) is associated with various detrimental outcomes among simultaneous pancreas and kidney (SPK) recipients. However, its potential risk associated with infection and rejection remains unclear. Methods: We compared recipients with K-DGF to those without K-DGF among all adult SPK recipients transplanted at our center between 01/2010 and 12/2022 who had pancreas graft survival of more than 2 weeks. Outcomes of interest included urinary tract infections (UTI) and pneumonia, along with pancreas and kidney graft rejections, within one-year post-transplant. Results: 543 SPK recipients were included, of whom 47 (9.5%) developed K-DGF. A total of 89 recipients had UTI, 33 had pneumonia, 77 had pancreas rejection and 21 had kidney rejection within one-year post-transplant. Recipients with K-DGF experienced a higher incidence of UTI. This association remained after adjustment for baseline characteristics (adjusted Hazard Ratio [aHR]: 3.06; 95% CI: 1.46-6.42; p=0.003). Similarly, K-DGF was associated with increased risk for kidney rejection in an unadjusted and adjusted models (aHR: 5.47; 95% CI: 1.98-15.1, p=0.001). K-DGF was not associated with pneumonia or pancreas rejection. Conclusion: K-DGF among SPK recipients is associated with an increased risk for UTI and kidney allograft rejection, likely related to dysregulation of the immune system. Close monitoring and appropriate management are warranted in these unique patient populations. Funding: Private Foundation Support