Rate, Factors, and Outcome of Delayed Graft Function After Kidney Transplantation of Deceased Donors

Delayed graft function (DGF) is a frequent complication after kidney transplantation affecting long-term outcome. A total of 525 consecutive recipients (age 54.2 .. 13.4 years, 33% female) of kidneys from deceased donors transplanted between 2005 and 2012 were retrospectively examined. DGF was defined as the need of dialysis within the first week after transplantation. DGF developed in 21.1% (n = 111). Factors associated with DGF (P ..± .035, respectively) were recipient body mass index, C-reactive protein of the recipient, residual diuresis, cold ischemia time, donor age, and diuresis in the first hour after transplantation. Median duration of DGF was 16 (2-66) days. Patients after DGF had a significantly lower GFR compared with recipients without DGF either after 3 (32.9 .. 16.5 vs 46.3 .. 18.4 mL/min/1.73 m2) or after 12 months (38.9 .. 19.3 vs 48.6 .. 20.4 mL/min/1.73 m2, P < .001, resp.). During DGF, 12.4% developed BANFF II and 18.0% BANFF I rejection, 20.2% had signs of transplant glomerulitis (first biopsy), and 16.2% (n = 18) remained on dialysis. DGF affects 1 out of 5 kidney transplants from deceased donors. Minimizing modifiable risk factors, in particular immunologic risk, may ameliorate the incidence and outcome of DGF. The outcome of DGF depends mainly on the diagnosis of any rejection and worsens upon detection of transplant glomerulitis and pronounced interstitial fibrosis and tubular atrophy (IFTA). ...DGF affects 1 in 5 kidney transplants of deceased kidney donors and is associated with poorer graft function...Appropriate donor and recipient selection taking into account immunologic risk, recipient BMI, cold ischemia time, and donor age, as well as residual diuresis and the c-reactive protein of the recipient could help to reduce the incidence of DGF...The outcome of DGF depends mainly on the exclusion of any rejection and worsens upon detection of transplant glomerulitis and pronounced IFTA. Thus, (repetitive) biopsies of the transplanted kidney should be performed in the case of sustained DGF...Diuresis within the first hour can be valued as an early sign against DGF.