Detrimental Outcomes Associated with Kidney Delayed Graft Function Persist Beyond the Short-Term

Background: Delayed graft function (DGF) is associated with acute rejection and decreased graft survival mainly in the early post-transplant period. However, its impact beyond this time is not well known. Methods: All deceased donor kidney-only transplant recipients at our center between 01/2000 and 06/2021 were stratified based on DGF status (+ vs. –). Adjusted hazard ratios (aHR) of uncensored graft failure (UGF), death-censored graft failure (DCGF), death with a functioning graft (DWFG), and acute rejection (AR) were analyzed within the short-term (0-6 months) and mid-term (7-36 months). Results: Out of 3093 recipients, 894 (28.9%) experienced DGF. Table 1 contains the aHR values for DGF + recipients comparing all four outcomes in the short- and mid-term. In the short-term, DGF was associated with an increased risk for UGF, DCGF, DWFG, and AR. Even in the mid-term outcomes, DGF was associated with an increased risk for UGF (aHR: 1.41, 95% CI: 1.13-1.77) and DWFG (aHR: 1.60, 95% CI: 1.15-2.36), but not for DCGF (aHR: 1.25, 95% CI: 0.93-1.70) or AR (aHR: 1.11, 95% CI: 0.78-1.58) [Table 1]. Figure 1 contains the Kaplan-Meier curves comparing the outcomes among DGF + and – recipients over 36 months. Conclusion: Recipients with DGF remained at significantly higher risk of UGF and DWFG beyond the first 6 months, although the associations were weaker than during the first 6 months. Close follow-up for patients with DGF may mitigate these mid-term outcomes.Table 1: Association of DGF with short- and mid-term outcomesFigure 1: Kaplan-Meier Curves of Outcomes