Assessing and comparing rival definitions of delayed renal allograft function for predicting subsequent graft failure

Transplantation. 2010 Nov 27;90(10):1113-6. doi: 10.1097/TP.0b013e3181f86966.


Background: The traditional definition of delayed graft function (DGF) rests on dialysis requirement during the first postoperative week. Subsequently, a more objective and "functional" definition of DGF (fDGF) has been proposed as an alternative to this dialysis-based definition of DGF (dDGF) and defined as a failure of the serum creatinine to decrease by at least 10% daily on 3 successive days during the first week posttransplantation, irrespective of dialysis requirement. However, an association between fDGF and long-term graft failure has not been fully established, and it is unknown whether fDGF is a better marker of subsequent outcomes than dDGF.

Methods: We studied 750 adult deceased donor kidney transplant recipients (1996-2006) and analyzed the association between these two DGF definitions and long-term graft outcome.

Results: Univariable associations with death-censored graft failure were seen for both dDGF and fDGF (hazard ratio [HR] 1.59; 95% confidence interval [CI] 1.16-2.18; P=0.004 and HR 1.72; 95% CI 1.26-2.36; P=0.001, respectively). On bivariable analysis (dDGF vs. fDGF), dDGF lost significance, whereas the effect of fDGF persisted (HR 1.52; 95%CI 1.03-2.25; P=0.04). This was also the case in a multivariable model, where fDGF but not dDGF was significantly associated with graft failure (HR 1.47; 95%CI 1.06-2.03; P=0.02). Results were similar for overall graft failure.

Conclusions: This study confirms the utility of fDGF as an early marker of subsequent inferior allograft outcomes, suggesting superiority over the traditional (often subjective) dialysis-based definition. Wider adoption of the fDGF definition should be considered, both as a risk-stratification tool in clinical practice and a clinical trial endpoint.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Creatinine / blood
  • Delayed Graft Function / diagnosis*
  • Delayed Graft Function / etiology*
  • Delayed Graft Function / physiopathology
  • Female
  • Follow-Up Studies
  • Graft Rejection / etiology
  • Humans
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / physiology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prognosis
  • Renal Dialysis
  • Risk Factors
  • Tissue Donors
  • United Kingdom


  • Creatinine