title: Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol.
abstract: OBJECTIVE
  To analyse the risk factors and outcomes of delayed graft function (DGF) in patients receiving a steroid sparing protocol.
  
  
  METHODS
  Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135 (31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression protocol.
  
  
  RESULTS
  Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function (PGF) group respectively,P= 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively,P< 0.001. Overall rejection free survival was no different between the DGF and PGF groups with a 1 and 5 year rejection free survival in the DGF group of 77.7% and 67.8% compared with 81.3% and 75.3% in the PGF group,P= 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis vintage.
  
  
  CONCLUSIONS
  Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF.
authors.affiliation: Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom.
authors.forename: Michelle
authors.initials: M
authors.lastname: Willicombe
authors.affiliation: Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Rizzello
authors.affiliation: Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom.
authors.forename: Dawn
authors.initials: D
authors.lastname: Goodall
authors.affiliation: Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papalois
authors.affiliation: Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom.
authors.forename: Adam G
authors.initials: AG
authors.lastname: McLean
authors.affiliation: Michelle Willicombe, Anna Rizzello, Dawn Goodall, Vassilios Papalois, Adam G McLean, David Taube, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London W12 0HS, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Taube
keywords: Alemtuzumab; Allograft failure; Cold ischaemic time; Deceased donors; Delayed graft function; Rejection; Steroid sparing