ASSOCIATION BETWEEN DURATION OF DELAYED GRAFT FUNCTION AND ALLOGRAFT OUTCOME AFTER KIDNEY TRANSPLANTATION

WH LIM1, D JOHNSON2, G WONG3

1Sir Charles Gairdner Hospital, Perth; 2Princess Alexandra Hospital, Queensland; 3Westmead Hospital, New South Wales 

Aim: To examine the association between duration of delayed graft function (DGF) and long-term graft outcome.

Background: Although a short duration of DGF may have no impact on graft outcome, the threshold of DGF associated with an adverse effect on out- come remains poorly defined.

Methods: In Australian and New Zealand, primary deceased donor kidney transplant recipients between 1994-2014 who had experienced DGF requiring dialysis were included. The associations between DGF duration and death censored graft loss (DCGL) and acute rejection at 6 months were examined using adjusted Cox regression analysis.

Results: Of 1718 kidney transplant recipients followed for a median of 5.4 years, 618 (36.0%) required between 3-7 days of dialysis post-transplant (referent), compared to 200 (11.6%), 459 (26.7%) and 441 (25.7%) who had required 1-2 days, 8-14 days and >14 days of dialysis, respectively. DGF duration of 8-14 and >14 days were associated with adjusted hazard ratios (HR) for acute rejection of 1.30 (95%CI 1.01, 1.67) and 1.93 (95%CI 1.52, 2.45), respectively. Compared to DGF duration of 3-7 days, DGF duration of >14 days was associated with adjusted HR for DCGL between 0-1 year of 3.00 (95%CI 1.59, 5.68), 2.14 (95%CI 1.35, 3.41) between 1-5 years, and 0.75 (95%CI 0.42, 1.31) between 5-10 years, independent of rejection. There was no association between DGF of 1-2 or 8-14 days and DCGL.

Conclusions: DGF of more than 14 days strongly increases the risk of DCGL independent of rejection. However, this association was time-dependent, with the excess risk of DCGL confined to within the first 5 years post-transplant. Future research evaluating interventions that aim to reduce DGF duration in susceptible kidney transplant recipients is urgently required.

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The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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