Abstract: SA-PO1176
A Stepwise Gradient of Delayed Graft Function Across Never, Former, and Current Pretransplant Midodrine Users: A Single-Center Retrospective Analysis
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
- Gopireddy, Naga Sumanth Reddy, University of Iowa Health Care, Iowa City, Iowa, United States
- Khawaja, Imran, University of Iowa Health Care, Iowa City, Iowa, United States
- Kuppachi, Sarat C., University of Iowa Health Care, Iowa City, Iowa, United States
- Swee, Melissa L., University of Iowa Health Care, Iowa City, Iowa, United States
Background
Pretransplant midodrine use is associated with delayed graft function (DGF) and graft loss after kidney transplantation, but whether this reflects a drug-mediated effect or a marker of hemodynamic fragility remains unresolved. Prior studies used binary current-vs-non-user designs and could not separate drug from phenotype. We added a former-user group to disentangle these mechanisms.
Methods
We conducted a single-center retrospective cohort study of 855 adult kidney-alone recipients at the University of Iowa, classified by chart-confirmed midodrine exposure: current users (n=36), former users (discontinued ≥1 month before transplant; n=13), and never users (n=806). Dual-organ kidney transplants (liver-, heart-, lung-, or pancreas-kidney) and recipients of prior non-kidney solid-organ transplants were excluded. The primary outcome was DGF (dialysis within 7 days post-transplant). Multivariable logistic regression adjusted for age, sex, BMI, diabetes mellitus, and donor type. A prespecified one-sided Cochran-Armitage trend test evaluated the ordered gradient (never < former < current). Deceased-donor and donor-stratified sensitivity analyses were prespecified.
Results
DGF rates followed a stepwise gradient: 7.1% (never), 18.8% (former), and 37.5% (current) (Cochran-Armitage Z=6.24, p<0.001; Table 1). Current midodrine use was independently associated with DGF (adjusted OR 4.8, 95% CI 2.0–11.7; p<0.001),with a consistent estimate in the deceased-donor sensitivity cohort (adjusted OR 4.6, 95% CI 1.8–11.4; p=0.001), with DBD (unadjusted OR 8.40, p=0.001) and DCD (OR 3.30, p=0.076). Former users carried the highest median KDPI (67.5) compared to current (33.0) or never users (34.5). Current users had longer hospital length of stay (6 vs 5 days; p=0.021) and higher ICU utilization (p=0.004). One-year graft survival was 91.2% (current) and 93.8% (former).
Conclusion
A stepwise DGF gradient across three exposure groups, combined with a robust adjusted OR consistent across all sensitivity analyses, supports a drug-timing component to the midodrine-DGF association beyond hemodynamic phenotype alone. Active pretransplant midodrine use represents a potentially modifiable pharmacological DGF risk factor; prospective evaluation of elective discontinuation prior to transplantation is warranted.