Mortality Linked to Duration of Delayed Graft Function
Deepa Jayaram, MD
SAN DIEGO—The duration of delayed graft function (DGF) influences mortality risk among renal transplant recipients surviving 90 days after transplantation, a study found.
Each added day of DGF is associated with a 2% increased risk of death, researchers reported here at the 2010 American Transplant Congress. In addition, each added day of DGF is associated with a 4% increased risk of acute rejection within six months following transplantation. It is possible that the impact of duration of DGF on patient death may be mediated through the effects of acute rejection, the investigators stated.
The study, led by transplant nephrology fellow Deepa Jayaram, MD, of the University of Michigan in Ann Arbor, included 683 renal transplant recipients, of whom 180 (26.4%) had DGF. The mean and median duration of DGF was 11.9 and five days, respectively.
DGF occurred in 21.4% of the 513 patients who received standard criteria donor kidneys; 50.6% of those who received donation after cardiac death (DCD) donor kidneys; and 34.4% of subjects who received expanded criteria donor (ECD) kidneys.
Patients who received DCD kidneys had a 3.56 times significantly increased odds of having DGF. Recipients who had coronary artery disease had a significant 81% increased odds. Each one-year increment in donor age was associated with a significant 2% increased odds.
Among subjects with DGF, having a DCD kidney was associated with a significant twofold increased likelihood of having an additional day of DGF. Each one-year increment in recipient age at transplant was associated with a significant 2% increased odds of having an additional day of DGF.
Knowledge of the factors that influence the risk and duration of DGF could be of prognostic value, particularly in the allocation of ECD and DCD kidneys to older recipients, Dr. Jayaram said. The findings also support the need for efforts to reduce the duration of DGF as well as the need for early diagnosis and treatment of acute rejection in patients with DGF in an attempt to improve clinical outcomes.