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. 2025 Oct 14;14(20):7240.
doi: 10.3390/jcm14207240.

Delayed Graft Function and Its Duration as Predictors of Medium-Term Kidney Transplant Outcomes: A Retrospective Cohort Study from an Eastern European Center

Oana Antal  1   2 , Tudor Moisoiu  2   3 , Robert Simon  1   2   4 , Alina Daciana Elec  2 , Adriana Milena Muntean  2 , Georgeta Horciag  2 , Florina Maria Gabor Harosa  5 , Vlad Pastor  6 , Horia Iuga  6 , Florin Ioan Elec  2   7
Affiliations

Delayed Graft Function and Its Duration as Predictors of Medium-Term Kidney Transplant Outcomes: A Retrospective Cohort Study from an Eastern European Center

Oana Antal et al. J Clin Med. .

Abstract

Background/Objectives: Delayed graft function (DGF) is a major complication after kidney transplantation, affecting graft and patient survival. Although well-studied in Western populations, data from Eastern Europe are limited, and the prognostic significance of DGF severity, particularly renal replacement therapy (RRT) duration, is not well-defined. Methods: We conducted a retrospective analysis of 479 adult recipients of brain-dead donor (DBD) kidney transplants at a high-volume transplant center in Romania (2017-2024). DGF was defined as the need for dialysis within seven days' post-transplant. Baseline characteristics, graft function, and survival outcomes were compared between DGF and non-DGF groups. Kidney function was evaluated using the Estimated Glomerular Filtration Rate (eGFR). Patient and graft survival were assessed using Kaplan-Meier curves and log-rank tests. DGF severity was stratified by RRT duration (≤14 vs. >14 days). Results: DGF occurred in 28.8% of patients (adjusted 24%). Those with DGF had a higher Body Mass Index (BMI), greater comorbidity (Charlson Index, Estimated Post-Transplant Survival (EPTS) score), longer pre-transplant dialysis, and higher Kidney Donor Profile Index (KDPI) donor kidneys. DGF was associated with lower graft survival at one, three, and five years and reduced patient survival at three and five years. Longer RRT was associated with progressively worse outcomes, with the poorest prognosis in patients needing >14 days. Conclusions: Delayed graft function was significantly associated with reduced graft and patient survival. Prolonged DGF time was found to be predictive for poorer outcomes.

Keywords: delayed graft function (DGF); graft survival; kidney transplantation; patient survival; renal replacement therapy (RRT) duration.

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Conflict of interest statement

Author Tudor Moisoiu was employed by the Biomed Data Analytics SRL. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Chronic Kidney Disease Epidemiology Collaboration score (CKD-EPI) at 1 month (A), 1 year (B), 3 years (C), and 5 years (D) post-kidney transplantation (KTx).
Figure 2
Figure 2
Freedom-from-Death Censored Graft Failure (DCGF) and Freedom-from-Death While Functioning Graft (DWFG) survival at 1 (A), 3 (B), and 5 years (C). The blue part represents the Non DGF group and the red one represents the DGF group.
Figure 3
Figure 3
Five-year renal graft (A) and patient (B) survival rates according to the length of renal replacement therapy (RRT) after transplant.
Figure 4
Figure 4
Five-year renal graft survival according to DGF severity.
See this image and copyright information in PMC

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