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Transplantation. 2016 Aug 4. [Epub ahead of print]

Delayed graft function phenotypes and 12-month kidney transplant outcomes.

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1Department of Medicine, Division of Nephrology, Hypertension & Renal Transplantation, University of Utah School of Medicine, Salt Lake City, UT2Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA3Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA4Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA5Wayne State University, Detroit, MI6Saint Barnabas Medical Center, Livingston, NJ7Section of Nephrology, University Hospital, Ulm, Germany8Section of Nephrology, Yale University School of Medicine, New Haven, CT9Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT10Veterans Affairs Connecticut Healthcare System, New Haven, CT.



Ischemia-reperfusion injury (IRI) leading to delayed graft function, 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 >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% CI)-by 7.3 (3.6-10.9) and 7.4 (3.8-11.0) ml/min/1.73m, respectively. Adjusted relative risks for 12-month eGFR <30 ml/min/1.73m 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 with12-month eGFR, and POD5 creatinine and creatinine reduction between POD1-2 demonstrated modest separations in 12-month eGFR.


While UNOS-DGF does not adequately predict 12-month function on its own, our findings do not support changing the definition. POD7 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.

[Available on 2018-02-04]
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