Postkidney Transplant Delayed Graft Function Outcomes Are Not Worsened by Deceased Donor Type

Abstract

Introduction: Kidney-delayed graft function (DGF) is more common in donation after circulatory death (DCD) donors in comparison to donatation after brain death (DBD). We analyzed deceased kidney transplant recipients (DDKTR) at our center between 2005 and 2019, stratified by donor type (DBD vs. DCD).

Methods: We assessed risk factors for DGF, acute rejection (AR), graft failure (GF), along with the death with functioning graft (DWFG), and the interaction between types of donors for those complications.

Results: Among 2543 DDKTRs, 804 (32%) were from DCD donors. Older donor age, higher recipient body mass index, and receipt of a depleting induction agent were associated with increased risk for DGF in both DBD and DCD. In contrast, preemptive transplant and female recipient gender were associated with reduced risk. Additional risk factors in DBD, but not in DCD recipients, included higher donor terminal serum creatinine, higher kidney donor profile index, right donor kidney, and prolonged cold ischemia time. Female donors were associated with a reduced risk of DGF only among DCD donors. DGF was associated with higher AR and GF, with no significant differences across donor types, DBD vs. DCD (AR: adjusted hazard ratio [aHR] 2.22 vs. 2.37, p-interaction = 0.65; GF: 3.04 vs. 2.56; p-interaction = 0.47). DGF was associated with a higher risk for DWFG among DBD (aHR: 3.43, 95% CI: 1.96-6.00, p < 0.001) but not with DCD (aHR: 1.90, 95% CI: 0.78-4.61, p = 0.16), with p-interaction of 0.15 CONCLUSION: Despite higher DGF rates in DCD, early adverse outcomes after DGF were similar between deceased donor types and should not deter the utilization of DCD kidneys.

Keywords: DGF; deceased donor; kidney transplant; outcomes; risk factors.

FIGURE 1

Outcomes comparing types of deceased donors with and without delayed graft function.