title: Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis.
abstract: BACKGROUND
  Delayed graft function (DGF) is a common complication of renal transplantation. The short-term consequences of DGF are well known, but the long-term relationship between DGF and patient and graft survival is controversial in the published literature. We conducted a systematic review and meta-analysis to precisely estimate these relationships.
  
  
  METHODS
  We performed a literature search for original studies published through March 2007 pertaining to long-term (>6 months) outcomes of DGF. The primary outcome was graft survival. Secondary outcomes were patient survival, acute rejection and kidney function.
  
  
  RESULTS
  When compared to patients without DGF, patients with DGF had a 41% increased risk of graft loss (RR 1.41, 95% CI 1.27-1.56) at 3.2 years of follow-up. There was no significant relationship between DGF and patient survival at 5 years (RR 1.14, 95% CI 0.94-1.39). The mean creatinine in the non-DGF group was 1.6 mg/dl. Patients with DGF had a higher mean serum creatinine (0.66 mg/dl, 95% CI 0.57-0.74) compared to patients without DGF at 3.5 years of follow-up. DGF was associated with a 38% relative increase in the risk of acute rejection (RR 1.38, 95% CI 1.29-1.47).
  
  
  CONCLUSIONS
  The results of this meta-analysis emphasize and quantify the long-term detrimental association between DGF and important graft outcomes like graft survival, acute rejection and renal function. Efforts to prevent and treat DGF should be aggressively investigated in order to improve graft survival given the deficit in the number of kidney donors.
authors.affiliation: Section of Nephrology, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Sri G
authors.initials: SG
authors.lastname: Yarlagadda
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Richard N
authors.initials: RN
authors.lastname: Formica
authors.forename: Emilio D
authors.initials: ED
authors.lastname: Poggio
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D051799:Delayed Graft Function / Q000209:etiology / Q000401:mortality*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D015996:Survival Rate