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Observational Study
. 2017 Aug;101(8):1913-1923.
doi: 10.1097/TP.0000000000001409.

Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes

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Free PMC article
Observational Study

Delayed Graft Function Phenotypes and 12-Month Kidney Transplant Outcomes

Isaac E Hall et al. Transplantation. .
Free PMC article

Abstract

Background: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Conflict of interest statement

The authors have no relevant financial conflicts of interest to report.

Figures

Figure 1
Figure 1
Study flow diagram. SPK, simultaneous pancreas-kidney transplant.
Figure 2
Figure 2
Basis spline curves. A. 12-month estimated glomerular filtration reate (eGFR) vs. postoperative day 7 serum creatinine concentration (POD7Cr, log2-transformed). B. 12-month eGFR vs. number of dialysis sessions in the first week. Solid line represents the penalized basis spline curve fit with 10 knots and automatically selected smoothing parameter. Shaded area represents the 95% confidence limits.
Figure 3
Figure 3
Mean 6, 12 and 24-month estimated glomerular filtration rate (eGFR) by dialysis number and duration. Standard error bars are shown above and below each mean value. A total of 215 recipients were dialyzed at least once in the first week of dialysis. A dotted vertical line separates the different dialysis-based criteria for the cohort.

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