Trends and determinants of graft function in deceased donor kidney transplantation: influence of donor, recipient, and perioperative factors across eras

Background: Deceased donor kidney transplantation outcomes are influenced by donor, recipient, and perioperative variables. This study evaluates the impact of donor age, dialysis duration, and cold ischemia time (CIT) on graft survival. Methods: A retrospective analysis of demographic, clinical, and perioperative data of 160 deceased donor kidney transplants (1998-2024) was done. Graft survival was estimated using Kaplan-Meier methods, and determinants were assessed using multivariable regression and logistic models. Slow graft function (SGF) was defined as serum creatinine >2.5 mg/dL at 7 days posttransplant. Results: The mean recipient and donor ages were 36.1±10.5 and 46.1±17.1 years, respectively. One-, 5-, and 10-year death-censored graft survival rates were 96.8%, 92.3%, and 82.1%, respectively; corresponding uncensored survivals were 90.1%, 77.8%, and 67.6%. A clear improvement in graft survival was noted across eras, with 1-year death-censored survival rising from 82% (1998-2003) to over 97% (2020-2024), reflecting advancements in immunosuppression, infection control, and ischemia management. Prolonged renal replacement therapy (RRT) vintage was significantly associated with poorer graft survival in univariate analysis. Donor age showed a mild, nonsignificant inverse association, while CIT had a weak, nonindependent effect on long-term survival. SGF occurred in 36.2% of recipients; logistic regression identified CIT as a significant predictor (P=0.016), with each hour of ischemia increasing the odds by 10% to 12%. Conclusions: RRT vintage adversely affects graft survival, while extended CIT increases early graft dysfunction risk. Progressive improvement across transplant eras underscores the benefits of modern transplant logistics and perioperative management.