Abstract: SA-PO1173
Standardized Dialysis Communication to Support Recovery from Delayed Graft Function After Kidney Transplantation
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
- Paul, Rohan Singh, Washington University in St Louis, St. Louis, Missouri, United States
- Kurwicki, Karli, BJC Health System, St. Louis, Missouri, United States
- Wertin, Heather Warrington, BJC Health System, St. Louis, Missouri, United States
- Barron, Tanya K., BJC Health System, St. Louis, Missouri, United States
- Alhamad, Tarek, Washington University in St Louis, St. Louis, Missouri, United States
Background
Delayed graft function (DGF) after kidney transplantation (KT) commonly entails outpatient dialysis. Limited KT-to-dialysis handoff may lead to pre-KT estimated dry-weight (EDW) use, excessive ultrafiltration (UF) and hypotension that may prolong DGF. Informed by ASN AKI-D guidance identifying fragmented transitions, UF and hypotension as modifiable threats to renal recovery, we evaluated whether a standardized DGF discharge template reduced HD dependence and HD-related readmissions.
Methods
We performed a preliminary pre/post QI analysis of individuals with DGF. The intervention was a standardized template (Figure 1) sent to the receiving HD units. It specified updated EDW, UF limits, BP goals, and midodrine instructions. The goal was to optimize graft perfusion and facilitate DGF recovery. Primary non-function cases were excluded from DGF duration analysis.
Results
36 patients were analyzable: 26 pre- and 10 post-intervention. Of note 4 pre-intervention cases had primary non-function. The intervention cohort was higher risk, with more DCD donors, 90.0% vs 77.3%, and diabetes, 70.0% vs 45.5%; age and sex were similar. Mean time to graft function emergence decreased from 30.3 to 24.1 days, mean difference −6.2 days. Differences were not significant by Welch t-test, p=0.38, or Mann-Whitney U test, p=0.90. HD-related readmission occurred in 9/21 pre-intervention patients, 42.9%, versus 3/10 post-intervention patients, 30.0%, absolute reduction 12.9 percentage points, odds ratio 0.57; Fisher exact p=0.70.
Conclusion
In this ongoing QI study, a DGF discharge template was associated with shorter DGF duration and fewer HD-related readmissions despite use in higher-risk patients. Although underpowered and not statistically significant, this early data supports ongoing evaluation of this tool which already shows a trend in promoting allograft recovery after DGF.
Acknowledgment
This QI project was supported by the AAKP Jenny Kitsen Patient Safety Grant, 2026.
| Measure | Pre-intervention | Post-Intervention |
| Patients analyzed | 22 (4 patients with primary non-function excluded) | 10 |
| DCD donors / Diabetes | 77.3% / 45.5% | 90.0% / 70% |
| DGF Duration (mean)* | 30.3 | 24.1 |
| HD-associated readmission** | 42.9% | 30.0% |
P-values: *p=0.38; **p=0.70
Figure 1
Funding
- Private Foundation Support