Abstract: TH-PO919

Delayed Graft Function in Living Donor Kidney Transplantation – Risk Factors and Outcomes

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Mogulla, Manohar Reddy, Central and Northern Adelaide Renal and Transplantation services, Adelaide, South Australia, Australia
  • Clayton, Philip A, Central and Northern Adelaide Renal and Transplantation services, Adelaide, South Australia, Australia
Background

Delayed graft function (DGF) is associated with poorer outcomes in deceased donor renal transplantation recipients. The association of DGF in living donor kidney transplantation has not been well studied. This study reviews the risk factors for DGF in Australia and New Zealand living donor kidney transplant recipients and its association with short and long term outcomes.

Methods

Data that had been prospectively collected in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was reviewed. The inclusion criteria were all adult living donor kidney transplants performed between 2004 and 2015. Data from pediatric recipients (<18 years) and donors with pre-existing renal pathology (n=404), with incomplete data (n=46) and those with early graft loss (graft loss within 1 week of implantation) (n=38) were excluded. The variables studied included multivariable logistic regression to identify the risk factors for DGF and the association between DGF and rejection at 6 months; linear regression model to examine the association with eGFR at 1 year; and Cox proportional hazards models to examine the relationships between DGF and patient and graft survival.

Results

We observed DGF in 77 (2.3%) of 3358 transplants. Risk factors for DGF included right-sided kidney (odds ratio [OR] 2.00 [95% CI 1.18-3.40]); donor BMI ( OR 1.06 [95% CI 1.01 - 1.12]); increasing time on dialysis and total ischemia time (OR 1.09 per hour [1.00-1.17]). DGF was associated with increased risk of rejection, worse patient and graft survival, and lower renal function at 1 year (Table).

Conclusion

In living donor kidney transplants DGF is uncommon but associated with significantly worse outcomes. The only modifiable risk factor identified was total ischemia time. Attention towards minimization of ischemia time in high-risk patients is recommended.

outcomes
OutcomeEstimate typeEstimate95% CIp-value
RejectionOdds Ratio2.371.41 - 3.970.001
Patient survivalHazard ratio2.141.21 - 3.100.009
Graft survivalHazard ratio1.981.27 - 3.100.003
eGFR at 1 yearCoefficient-9.57-13.5 - -5.64<0.001