title: Prolonged Delayed Graft Function Is Associated with Inferior Patient and Kidney Allograft Survivals.
abstract: It is unclear if there is an association between the duration of delayed graft function (DGF) and kidney transplant (KT) outcomes. This study investigated the impact of prolonged DGF on patient and graft survivals, and renal function one year after KT. This single center retrospective analysis included all deceased donor KT performed between Jan/1998 and Dec/2008 (n = 1412). Patients were grouped in quartiles according to duration of DGF (1-5, 6-10, 11-15, and >15 days, designated as prolonged DGF). The overall incidence of DGF was 54.2%. Prolonged DGF was associated with retransplantation (OR 2.110, CI95% 1.064-4.184,p = 0.033) and more than 3 HLA mismatches (OR 1.819, CI95% 1.117-2.962,p = 0.016). The incidence of acute rejection was higher in patients with DGF compared with those without DGF (36.2% vs. 12.2%, p<0.001). Compared to patients without DGF, DGF(1-5), DGF(6-10), and DGF(11-15), patients with prolonged DGF showed inferior one year patient survival (95.2% vs. 95.4% vs. 95.5% vs. 93.4% vs. 88.86%, p = 0.003), graft survival (91% vs. 91.4% vs. 92% vs. 88.7% vs. 70.5%, p<0.001), death-censored graft survival (95.7% vs. 95.4% vs. 96.4% vs. 94% vs. 79.3%, p<0.001), and creatinine clearance (58.0±24.6 vs. 55.8±22.2 vs. 53.8±24.1 vs. 53.0±27.2 vs. 36.8±27.0 mL/min, p<0.001), respectively. Multivariable analysis showed that prolonged DGF was an independent risk factor for graft loss (OR 3.876, CI95% 2.270-6.618, p<0.001), death censored graft loss (OR 4.103, CI95% 2.055-8.193, p<0.001), and death (OR 3.065, CI95% 1.536-6.117, p = 0.001). Prolonged DGF, determined by retransplantation and higher HLA mismatches, was associated with inferior renal function, and patient and graft survivals at one year.
authors.affiliation: Nephrology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Tainá Veras
authors.initials: TV
authors.lastname: de Sandes-Freitas
authors.affiliation: Nephrology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Cláudia Rosso
authors.initials: CR
authors.lastname: Felipe
authors.affiliation: Urology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Wilson Ferreira
authors.initials: WF
authors.lastname: Aguiar
authors.affiliation: Nephrology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Marina Pontello
authors.initials: MP
authors.lastname: Cristelli
authors.affiliation: Nephrology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Hélio
authors.initials: H
authors.lastname: Tedesco-Silva
authors.affiliation: Nephrology Division, Hospital do Rim / Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: José Osmar
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000328:Adult; D051799:Delayed Graft Function; D005260:Female; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult