Assessing and comparing rival definitions of delayed renal allograft function for predicting subsequent graft failure.
BACKGROUND
The traditional definition of delayed graft function (DGF) rests on dialysis requirement during the first postoperative week. Subsequently, a more objective and "functional" definition of DGF (fDGF) has been proposed as an alternative to this dialysis-based definition of DGF (dDGF) and defined as a failure of the serum creatinine to decrease by at least 10% daily on 3 successive days during the first week posttransplantation, irrespective of dialysis requirement. However, an association between fDGF and long-term graft failure has not been fully established, and it is unknown whether fDGF is a better marker of subsequent outcomes than dDGF.


METHODS
We studied 750 adult deceased donor kidney transplant recipients (1996-2006) and analyzed the association between these two DGF definitions and long-term graft outcome.


RESULTS
Univariable associations with death-censored graft failure were seen for both dDGF and fDGF (hazard ratio [HR] 1.59; 95% confidence interval [CI] 1.16-2.18; P=0.004 and HR 1.72; 95% CI 1.26-2.36; P=0.001, respectively). On bivariable analysis (dDGF vs. fDGF), dDGF lost significance, whereas the effect of fDGF persisted (HR 1.52; 95%CI 1.03-2.25; P=0.04). This was also the case in a multivariable model, where fDGF but not dDGF was significantly associated with graft failure (HR 1.47; 95%CI 1.06-2.03; P=0.02). Results were similar for overall graft failure.


CONCLUSIONS
This study confirms the utility of fDGF as an early marker of subsequent inferior allograft outcomes, suggesting superiority over the traditional (often subjective) dialysis-based definition. Wider adoption of the fDGF definition should be considered, both as a risk-stratification tool in clinical practice and a clinical trial endpoint.
Moore
Jason
J
Department of Nephrology and Transplantation, Renal Institute of Birmingham, University Hospital Birmingham, Birmingham, United Kingdom.
Shabir
Shazia
S
Chand
Sourabh
S
Bentall
Andrew
A
McClean
Andrew
A
Chan
Winnie
W
Jham
Seema
S
Benavente
David
D
Sharif
Adnan
A
Ball
Simon
S
Cockwell
Paul
P
Borrows
Richard
R
D000328:Adult; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D006435:Renal Dialysis; D012307:Risk Factors; D014019:Tissue Donors; D006113:United Kingdom
D003404:Creatinine