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Delayed Graft Function and the Risk for Death with a Functioning Graft

Shruti N. Tapiawala^*,, Kathryn J. Tinckam^*,,, Carl J. Cardella^*,, Jeffrey Schiff^*,, Daniel C. Cattran^*,, Edward H. Cole^*, and S. Joseph Kim^*,

^* Division of Nephrology and
Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, and
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada

Correspondence: Dr. S. Joseph Kim, Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11C-1183, Toronto, Ontario, Canada, M5G 2N2. Phone: 416-340-3228; Fax: 416-340-4701; E-mail: joseph.kim{at}uhn.on.ca

Received for publication April 18, 2009. Accepted for publication September 16, 2009.

Delayed graft function (DGF) associates with an increased risk for graft failure, but its link with death with graft function (DWGF) is unknown. We used the US Renal Data System to assemble a cohort of all first, adult, deceased-donor kidney transplant recipients from January 1, 1998, through December 31, 2004. In total, 11,542 (23%) of 50,246 recipients required at least one dialysis session in the first week after transplantation. Compared with patients without DGF, patients with DGF were significantly more likely to die with a functioning graft (relative hazard 1.83 [95% confidence interval 1.73 to 1.93] and 1.53 [95% CI 1.45 to 1.63] for unadjusted and fully adjusted models, respectively). The risk for DWGF was slightly higher among women with DGF than among men. There was no significant heterogeneity among other subgroups, and the results were robust to sensitivity analyses. Acute rejection within the first year attenuated the DGF–DWGF association. Cardiovascular and infectious deaths were slightly more prevalent in the DGF group, but the relative hazards of cause-specific death were similar between DWGF and deaths during total follow-up. In summary, DGF associates with an increased risk for DWGF; the mechanisms underlying the negative impact of DGF require further study.

Copyright © 2009 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673