Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation

17 August 2016  // 

Wu, et al. Kidney Int 2015;88(4):851–8.

Delayed graft function (DGF) is a common complication experienced by kidney transplant recipients and has been associated with poor clinical outcomes, making it a potential risk factor for acute rejection. This observational study aimed to evaluate the association of DGF and biopsy-driven acute rejection (BPAR) in kidney transplant recipients (n=645) in a Canadian transplant center over 12 years.

A total of 36.1% of kidney transplant recipients experienced DGF. During a median follow up of 3.5 years, there were 111 BPAR events, with 119 total graft failure events reported during a median follow up of 4.5 years. The 1-, 3- and 5-year probabilities of developing BPAR were 16%, 21.8% and 21.8%, respectively, in the DGF group, versus 10.1%, 12.4% and 15.7%, respectively, in the non-DGF group. A multivariable cox proportional hazard model determined that DGF was associated with an unadjusted hazard ratio of 1.55 for BPAR over the follow-up period. DGF was also associated with a higher cumulative probability of developing antibody-mediated and T-cell-mediated rejection (hazard ratios of 1.52 and 1.54 vs non-DGF groups). These results were generally persistent across all definitions of DGF, and despite changes in the maintenance immunosuppression regimen over follow up.

With results consistent with previously published reports, this study confirms that DGF remains an important risk factor for BPAR in kidney transplantation and emphasizes the importance of optimizing immunosuppression in patients with DGF.