Delayed graft function (DGF) increases patient mortality risks over the short- and long-term after kidney transplantation (KT), according to new study findings presented at the virtual American Transplant Congress 2021.

Of 95,271 adult recipients of a primary, deceased-donor kidney (mean age 53.5 years; 60.6% male; 33.3% Black) within the 2005-2015 Organ Procurement and Transplantation Network (OPTN) database, 25.8% had DGF and required dialysis within the first 7 days. Over time, 33.5% with DGF and 24.7% without DGF died.

Patient survival at 1, 5, and 10 years was significantly lower among patients with DGF: 93.1%, 75.9%, and 47.3% in the DGF group compared with 96.9%, 85.1%, and 62.0% in the no DGF group, respectively, William Irish, PhD, of East Carolina University in Greenville, North Carolina, and colleagues reported. The risk for early mortality within the first year of KT was 2.0-fold higher for patients with than without DGF. The risk for late mortality was 1.4-fold higher with DGF.

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Results were adjusted for donor age, kidney donor profile index, donation after cardiac death, recipient age, sex, race, history of diabetes, and transplant year.

“We performed this analysis to see how long a shadow DGF casts,” Dr Irish told Renal & Urology News. “That DGF is associated with patient mortality for longer than 3 years is surprising. The effect of DGF on mortality is more pronounced in the first year after KT, but it is still impactful even after 5 years. We need further studies to find the cause of death and how DGF may be impacting those specific etiologies.”

The prevalence of DGF has increased in recent years, from 24.4% in 2005 to 29.9% in 2015, Dr Irish noted. These new research insights have the potential to improve management of patients with DGF, he said.


Irish W, Fu Y, Leeser DB, Ravindra KV, Haisch C, Tuttle J. The effect of delayed graft function on early versus late mortality following kidney transplantation. Am J Transplant. 2021;21 (suppl 3). Presented at the virtual American Transplant Congress 2021, June 5-9, 2021. Abstract 176.