title: Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes.
abstract: Ischemia-reperfusion injury (IRI) leading to delayed graft function (DGF), defined by the United Network for Organ Sharing as dialysis in the first week (UNOS-DGF), associates with poor kidney transplant outcomes. Controversies remain, however, about dialysis initiation thresholds and the utility for other criteria to denote less severe IRI, or slow graft function (SGF).
  
  
  
  Multicenter, prospective study of deceased-donor kidney recipients to compare UNOS-DGF to a definition that combines impaired creatinine reduction in the first 48 hours or greater than 1 dialysis session for predicting 12-month estimated glomerular filtration rate (eGFR). We also assessed 10 creatinine and urine output-based SGF definitions relative to 12-month eGFR.
  
  
  
  In 560 recipients, 215 (38%) had UNOS-DGF, 330 (59%) met the combined definition, 14 (3%) died, and 23 (4%) had death-censored graft failure by 12 months. Both DGF definitions were associated with lower adjusted 12-month eGFR (95% confidence interval)-by 7.3 (3.6-10.9) and 7.4 (3.8-11.0) mL/min per 1.73 m, respectively. Adjusted relative risks for 12-month eGFR less than 30 mL/min per 1.73 m were 1.9 (1.2-3.1) and 2.1 (1.1-3.7), with unadjusted areas under the curve of 0.618 and 0.627, respectively. For SGF definitions, postoperative day (POD) 7 creatinine had the strongest association with 12-month eGFR, and POD5 creatinine and creatinine reduction between POD1 and POD2 demonstrated modest separations in 12-month eGFR.
  
  
  
  Although UNOS-DGF does not adequately predict 12-month function on its own, our findings do not support changing the definition. Postoperative day 7 creatinine is correlated with 12-month eGFR, but large translational studies are needed to understand the biological link between IRI severity at transplant and longer-term outcomes.
authors: 1 Division of Nephrology, Hypertension & Renal Transplantation, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT. 2 Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA. 3 Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA. 4 Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA. 5 Division of Nephrology, Department of Medicine, Wayne State University, Detroit, MI. 6 Saint Barnabas Medical Center, Livingston, NJ. 7 Section of Nephrology, University Hospital, Ulm, Germany. 8 Section of Nephrology, Yale University School of Medicine, New Haven, CT. 9 Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT. 10 Veterans Affairs Connecticut Healthcare System, New Haven, CT.
authors: Isaac E
authors: IE
authors: Hall
authors: Peter P
authors: PP
authors: Reese
authors: Mona D
authors: MD
authors: Doshi
authors: Francis L
authors: FL
authors: Weng
authors: Bernd
authors: B
authors: Schröppel
authors: William S
authors: WS
authors: Asch
authors: Joseph
authors: J
authors: Ficek
authors: Heather
authors: H
authors: Thiessen-Philbrook
authors: Chirag R
authors: CR
authors: Parikh
mesh_terms: D003404:Creatinine / Q000378:metabolism; D051799:Delayed Graft Function / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010641:Phenotype; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine