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. 2015 Dec 17;10(12):e0144188.
doi: 10.1371/journal.pone.0144188. eCollection 2015.

Prolonged Delayed Graft Function Is Associated with Inferior Patient and Kidney Allograft Survivals

Tainá Veras de Sandes-Freitas  1 , Cláudia Rosso Felipe  1 , Wilson Ferreira Aguiar  2 , Marina Pontello Cristelli  1 , Hélio Tedesco-Silva  1 , José Osmar Medina-Pestana  1
Affiliations

Prolonged Delayed Graft Function Is Associated with Inferior Patient and Kidney Allograft Survivals

Tainá Veras de Sandes-Freitas et al. PLoS One. .

Abstract

It is unclear if there is an association between the duration of delayed graft function (DGF) and kidney transplant (KT) outcomes. This study investigated the impact of prolonged DGF on patient and graft survivals, and renal function one year after KT. This single center retrospective analysis included all deceased donor KT performed between Jan/1998 and Dec/2008 (n = 1412). Patients were grouped in quartiles according to duration of DGF (1-5, 6-10, 11-15, and >15 days, designated as prolonged DGF). The overall incidence of DGF was 54.2%. Prolonged DGF was associated with retransplantation (OR 2.110, CI95% 1.064-4.184,p = 0.033) and more than 3 HLA mismatches (OR 1.819, CI95% 1.117-2.962,p = 0.016). The incidence of acute rejection was higher in patients with DGF compared with those without DGF (36.2% vs. 12.2%, p<0.001). Compared to patients without DGF, DGF(1-5), DGF(6-10), and DGF(11-15), patients with prolonged DGF showed inferior one year patient survival (95.2% vs. 95.4% vs. 95.5% vs. 93.4% vs. 88.86%, p = 0.003), graft survival (91% vs. 91.4% vs. 92% vs. 88.7% vs. 70.5%, p<0.001), death-censored graft survival (95.7% vs. 95.4% vs. 96.4% vs. 94% vs. 79.3%, p<0.001), and creatinine clearance (58.0±24.6 vs. 55.8±22.2 vs. 53.8±24.1 vs. 53.0±27.2 vs. 36.8±27.0 mL/min, p<0.001), respectively. Multivariable analysis showed that prolonged DGF was an independent risk factor for graft loss (OR 3.876, CI95% 2.270-6.618, p<0.001), death censored graft loss (OR 4.103, CI95% 2.055-8.193, p<0.001), and death (OR 3.065, CI95% 1.536-6.117, p = 0.001). Prolonged DGF, determined by retransplantation and higher HLA mismatches, was associated with inferior renal function, and patient and graft survivals at one year.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. 6-months rejection-free survival according to time on DGF.
Patients with DGF longer than 15 days presented inferior rejection-free survival comparing with patients without DGF or DGF up to 5 days. Most episodes occurred within 30 days after transplant.
Fig 2
Fig 2. 1-year death censored graft survival according to DGF and AR episodes.
Patients with AR episodes and those with DFG and AR episodes presented inferior death censored graft survival.
Fig 3
Fig 3. 1-year death censored graft survival according to time on DGF.
Only patients with DGF longer than 15 days presented inferior death censored graft survival.
Fig 4
Fig 4. 1-year patient survival according to time on DGF.
Only patients with DGF longer than 15 days presented inferior patient survival.
Fig 5
Fig 5. Monthly renal function according to time on DGF.
Patients with prolonged DGF presented inferior renal function when compared with other groups.
See this image and copyright information in PMC

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