title: Does delayed graft function in the first kidney transplant influence graft outcome in a subsequent transplant?
abstract: BACKGROUND
  In kidney transplantation, delayed graft function (DGF) portends adverse graft and patient outcomes. It is unclear whether DGF in the first kidney transplant would adversely impact the outcome of a subsequent transplant.
  
  
  METHODS
  Utilizing data from the Organ Procurement and Transplant Network, we identified patients ≥ 18 years of age who underwent at least two deceased donor kidney transplantation (DDKT) between 1987 and 2010. Patients were then divided into two groups based on whether or not they developed DGF in the first transplant (1st TXP DGF group and 1st TXP no-DGF group). Unadjusted and adjusted graft survivals (Cox regression) between the groups were compared.
  
  
  RESULTS
  A total of 10,628 patients were identified who received more than one DDKT (3672 patients in the 1st TXP DGF group and 6956 patients in the 1st TXP no-DGF group). A higher incidence of DGF was observed with the second transplant in patients who had DGF in the first transplant (34% vs 26%, P = .001). Unadjusted graft survival for the second transplant was superior in the 1st TXP no-DGF group (P = .002). After correction for confounding variables, DGF in the first transplant did not have significant adverse impact on the graft survival of the second transplant (hazard ratio 1.2 with 95% confidence interval 0.96-1.09, P = .44).
  
  
  CONCLUSIONS
  In patients undergoing more than one DDKT, DGF in the first transplant is associated with higher incidence of DGF in the subsequent transplant but did not have independent adverse influence on the outcome of that graft.
authors.affiliation: Division of Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. ksureshk@wpahs.org
authors.forename: K K
authors.initials: KK
authors.lastname: Sureshkumar
authors.forename: R J
authors.initials: RJ
authors.lastname: Marcus
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome