title: Delayed graft function is not associated with an increased incidence of renal allograft rejection.
abstract: Delayed graft function (DGF) is considered as a risk factor for renal allograft rejection, but this association might be confounded by diagnostic biases (e.g., higher biopsy frequency in patients with DGF, inclusion of clinically diagnosed rejection episodes, and limited details on the rejection phenotype). This retrospective study including 329 deceased donor transplantations aimed to clarify a causal relationship between DGF and rejection. DGF occurred in 93/329 recipients (28%), whereas immediate graft function (IGF) in 236/329 recipients (72%). The percentage of patients with ≥1 allograft biopsy within the first year post-transplant was similar between the DGF and IGF group (96% vs. 94%; p=0.60). The cumulative one-yr incidence of biopsy-proven clinical (35% vs. 34%; p=0.62) and combined (sub)clinical rejection (58% vs. 60%; p=0.79) was not different between the two groups. Furthermore, there were no differences regarding rejection phenotypes/severities and time frame of occurrence. By multivariable Cox regression analysis, donor-specific HLA antibodies, younger recipient age, and immunosuppressive regimens were independent predictors for clinical rejection, while DGF was not. These results in an intermediate sized, but thoroughly investigated patient population challenge the concept that DGF is a risk factor for rejection and highlights the need for additional studies in this regard.
authors.affiliation: Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Basel, Switzerland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hirt-Minkowski
authors.forename: Patrizia
authors.initials: P
authors.lastname: Amico
authors.forename: Gideon
authors.initials: G
authors.lastname: Hönger
authors.forename: Claudia
authors.initials: C
authors.lastname: Praehauser
authors.forename: Jürg
authors.initials: J
authors.lastname: Steiger
authors.forename: Michael T
authors.initials: MT
authors.lastname: Koller
authors.forename: Lorenz
authors.initials: L
authors.lastname: Gürke
authors.forename: Michael
authors.initials: M
authors.lastname: Mayr
authors.forename: Stefan
authors.initials: S
authors.lastname: Schaub
mesh_terms: D000328:Adult; D000368:Aged; D051799:Delayed Graft Function / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate