Abstract: SA-PO1172
Changes by Era in Risk Factors and Outcomes Among Living Donor Kidney Transplant Recipients with Delayed Graft Function
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Ylagan, Camille, UW Health, Madison, Wisconsin, United States
- Strazny, Mia Josephine, UW Health, Madison, Wisconsin, United States
- Garg, Neetika, UW Health, Madison, Wisconsin, United States
- Thiessen, Carrie, UW Health, Madison, Wisconsin, United States
- Mandelbrot, Didier A., UW Health, Madison, Wisconsin, United States
- Astor, Brad C., UW Health, Madison, Wisconsin, United States
- Parajuli, Sandesh, UW Health, Madison, Wisconsin, United States
Background
Although living donor kidney transplant recipients (LDKTRs) have lower rates of delayed graft function (DGF), trends in outcomes of LDKTRs with DGF are less clear. We hypothesize that risk factors for DGF and outcomes among LDKTRs have changed over time.
Methods
LDKTRs were stratified by transplant year into two eras, E1 (2000-2011) and E2 (2012-2020), to align with the 2011 opening of an outpatient DGF clinic. We analyzed risk factors for DGF, along with one-year uncensored graft failure (UCGF), death-censored graft failure (DCGF), death with functioning graft (DWFG), and acute rejection (AR) by era.
Results
A total of 1964 LDKTRs were included (E1: 1081, E2: 883). The proportion of patients with DGF did not differ by era (p=0.53). Median duration of DGF (p=0.009) and median dialysis session count were lower in E2 (p=0.009).
Pre-transplant HD duration >1 year was associated with increased odds of DGF in each era when adjusting for baseline characteristics: E1 (aOR: 4.11, 95% CI: 1.54-11.04, p=0.005); E2 (aOR: 6.73, 95% CI: 1.95-23.27, p=0.003); p-int=0.54. Increased recipient BMI was associated with increased odds of DGF in each era when adjusted: E1 (aOR: 1.09, 95% CI: 1.02-1.16, p=0.02); E2 (aOR: 1.08, 95% CI: 1.00-1.16, p=0.04); p-int=0.85. HLA mismatch was associated with greater odds of DGF in E1 (aOR: 1.31, 95% CI: 1.02-1.67, p=0.03) but not in E2; p-int=0.93. Female donor was associated with a decreased odds of DGF in E2 (aOR: 0.43, 95% CI: 0.19-0.95, p=0.04) but not in E1; p-int=0.23.
The risk of one-year AR was lower in E2 (aHR: 0.34, 95% CI: 0.14-0.86, p=0.02) compared to E1. Kaplan-Meier analysis confirmed this (Figure 1).
Conclusion
The proportion of DGF did not change in the recent era, but the severity of DGF decreased. Some risk factors remained associated with DGF. First-year AR outcomes improved in 2012-2020 possibly due to improved management. These findings help contribute to proper donor and recipient pairing.
Figure 1. Kaplan-Meier analysis of first-year acute rejection in LDKTRs