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Abstract: PO2416

Outcomes of Delayed Graft Function: A Systematic Review and Meta-Analysis

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Sandra, Vanessa, Columbia University, New York, New York, United States
  • Sanichar, Navin, Columbia University, New York, New York, United States
  • Daniel, Emily, Columbia University, New York, New York, United States
  • Li, Miah T., Columbia University, New York, New York, United States
  • King, Kristen L., Columbia University, New York, New York, United States
  • Stevens, Jacob, Columbia University, New York, New York, United States
  • Husain, Syed Ali, Columbia University, New York, New York, United States
  • Mayne, Tracy J., Angion BioMedica, San Fransisco, California, United States
  • Mohan, Sumit, Columbia University, New York, New York, United States
Background

Delayed Graft Function (DGF) is a frequent complication of kidney transplantation, but its impact on long and short-term outcomes remain uncertain.

Methods

We conducted a literature search for studies investigating the association of DGF on subsequent outcomes from 2007-2020. Outcomes were abstracted and used to create cumulative forest plots with pooled odds ratios, stratifying our analysis between center-studies and registry-studies and follow-up time where possible. The outcomes analyzed were graft failure (GF), acute rejection (AR), patient survival, and renal function.

Results

Of the 1464 articles reviewed, 27 were included. In single center-studies, DGF patients experienced higher GF at 1 year (OR 2.45, 95% CI 1.79-4.29, p<0.001), 3 years (OR 1.70, 95% CI 1.01-2.86, p<0.001), increased AR 1-year post-transplant (OR 1.48, 95% CI 1.79-4.28, p=0.001), and decreased 1-year patient survival (OR 0.46, 95% CI 0.28-0.73, p<0.001). Registry-studies showed a similar significant association with GF at 1 year (OR 2.76, 95% CI 1.79-4.28, p<0.001) and 3 years (OR 1.70, 95% CI 1.01-2.86, p=0.046), with AR within 1 year (OR 1.48, 95% CI 1.45-8.67, p=0.005) and 3-years (OR 0.54, 95% CI 0.41-0.72, p<0.001), and 1-year survival (OR 0.45, 95% CI 0.26, 0.77, p<0.001). Qualitative analysis showed that DGF had significant effect on eGFR and creatinine levels, though studies conflict on timeframe. Few studies investigated outcomes stratifying DGF severity or KDPI.

Conclusion

DGF was associated with increased risk of GF, AR, and mortality, although effects were largest within 1 year post-transplant. Our analysis indicated a need for a standardized method to measure DGF severity and further studies on DGF outcomes on varying KDPI. These results should inform the selection process, treatment, and monitoring of transplanted kidneys at high risk for DGF.