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

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 Decemb...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2010, Vol.21 (1), p.153-161
Main Authors: TAPIAWALA, Shruti N, TINCKAM, Kathryn J, CARDELLA, Carl J, SCHIFF, Jeffrey, CATTRAN, Daniel C, COLE, Edward H, JOSEPH KIM, S
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Cause of Death
Clinical Epidemiology
Cohort Studies
Delayed Graft Function - complications
Female
Follow-Up Studies
Graft Survival - physiology
Humans
Kidney Failure, Chronic - surgery
Kidney Transplantation - mortality
Kidney Transplantation - physiology
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Proportional Hazards Models
Retrospective Studies
Risk Factors
Sex Characteristics
Young Adult
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Summary: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.
ISSN:1046-6673
1533-3450
DOI:10.1681/ASN.2009040412