Risk Factors and Outcome of Prolonged Recovery from Delayed Graft Function after Deceased Kidney Transplantation

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Abstract

Objective

To investigate the risk factors of prolonged recovery from delayed graft function (DGF) after deceased kidney transplantation and to evaluate the effect of prolonged recovery on the outcome.

Methods

We retrospectively analyzed 91 recipients with DGF after deceased kidney transplantation from 2007 to 2016 in our center. DGF recovery time is defined as the time required to achieve stable serum creatinine level. Recipients with DGF recovery time ≥ the median were assigned to the prolonged recovery group while the rest to the rapid recovery group.

Result

Ninety-one recipients with regular follow-up until graft function recovery were further divided into fast and prolonged recovery group. The median recovery time was 27 days (Interquartile range: 15-45 days). Donor terminal glomerular filtration rate (GFR) was significantly lower in the prolonged recovery group (N = 46) compared with the rapid recovery group (N = 45) (median 24.9 vs 65.4 ml/min/1.73m2, P=0.0036). There was a significant decrease in the GFR at 1 year post-transplant in the prolonged recovery group compared with the rapid recovery group (50.6±20.0 vs 63.5±21.4 ml/min/1.73m2, P =0.005). The prolonged recovery group was also at higher risk of composite end-point (acute rejection, pneumonia, graft failure and death; hazards ratio 2.604, 95% confidence interval 1.102-6.150, P=0.029) compared with the rapid recovery group.

Conclusion

Donor acute kidney injury is a risk factor of prolonged recovery from DGF after deceased kidney transplantation. Prolonged recovery time is associated with restricted recovery of graft function and poor transplant outcome.

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