title: The risk of allograft failure and the survival benefit of kidney transplantation are complicated by delayed graft function.
abstract: Concern about the long-term impact of delayed graft function (DGF) may limit the use of high-risk organs for kidney transplantation. To understand this better, we analyzed 29,598 mate kidney transplants from the same deceased donor where only 1 transplant developed DGF. The DGF associated risk of graft failure was greatest in the first posttransplant year, and in patients with concomitant acute rejection (hazard ratio: 8.22, 95% confidence interval: 4.76-14.21). In contrast, the DGF-associated risk of graft failure after the first posttransplant year in patients without acute rejection was far lower (hazard ratio: 1.15, 95% confidence interval: 1.02-1.29). In subsequent analysis, recipients of transplants complicated by DGF still derived a survival benefit when compared with patients who received treatment with dialysis irrespective of donor quality as measured by the Kidney Donor Profile Index (KDPI). The difference in the time required to derive a survival benefit was longer in transplants with DGF than in transplants without DGF, and this difference was greatest in recipients of lower quality kidneys (difference: 250-279 days for KDPI 20%-60% vs. 809 days for the KDPI over 80%). Thus, the association of DGF with graft failure is primarily limited to the first posttransplant year. Transplants complicated by DGF provide a survival benefit compared to treatment with dialysis, but the survival benefit is lower in kidney transplants with lower KDPI. This information may increase acceptance of kidneys at high risk for DGF and inform strategies to minimize the risk of death in the setting of DGF.
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcomes Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jsgill2@me.com.
authors.forename: Jagbir
authors.initials: J
authors.lastname: Gill
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jianghu
authors.initials: J
authors.lastname: Dong
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Caren
authors.initials: C
authors.lastname: Rose
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcomes Sciences, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D064591:Allografts / Q000473:pathology*; D051799:Delayed Graft Function / Q000150:complications* / Q000401:mortality; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality
keywords: acute rejection; delayed graft function; kidney transplantation; paired kidney analysis; survival; survival benefit