Slow graft function (SGF), a less severe form of poor kidney function than delayed graft function (DGF), is independently associated with worse long-term graft outcomes and patient survival compared with immediate graft function among recipients of kidneys from living and brain-dead donors, according to study findings presented at the 2023 American Transplant Congress held in San Diego, California.

“Slow graft function appears to have an important impact on long-term outcomes,” lead author Karthik Venkataraman, MBBS, of the Royal Adelaide Hospital and the University of Adelaide in Adelaide, Australia, told Renal & Urology News. “Interventions that reduce slow and delayed graft function thus could improve patient-centered clinical outcomes. Transplant registries should consider collecting and reporting on slow graft function.”

Although the adverse effect of DGF, which is the requirement for dialysis within 7 days after transplantation, on long-term graft outcomes is well documented, it has been unclear whether SGF (poor kidney function not requiring dialysis) also leads to worse graft outcomes, Dr Venkataraman explained. Also unclear is whether donor type influences the effect of SGF on graft outcomes.

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Dr Venkataraman and colleagues studied 17,579 adult kidney-only transplant recipients from 2001 to 2021 in the Australia and New Zealand Dialysis and Transplant Registry. The study population included 5904 recipients of living-donor kidneys, 9316 recipients of brain-dead donor kidneys, and 2359 recipients of kidneys donated following circulatory death. The investigators followed patients for a median of 7.3 years.

SGF in recipients of living-donor kidneys was significantly associated with a  1.5-fold increased risk for graft failure and a 1.6-fold increased risk for patient death in adjusted analyses, Dr Venkataraman reported. Among recipients of kidneys from brain-dead donors, SGF was significantly associated with a nearly 1.2-fold increased risk for graft failure but was not associated with patient survival. SGF was not significantly associated with graft or patient survival among recipients of kidneys from circulatory-death donors.

DGF was significantly associated with an approximately 2.1-, 1.4-, and 1.7-fold increased risk for graft failure in recipients of kidneys from living donors, brain-dead donors, and circulatory-death donors, respectively. DGF was also significantly associated with an approximately 2.0-, 1.4-, and 1.5-fold increased risk for patient death, respectively.


Venkataraman K, Irish G, Collins M, Clayton P. Associations between slow graft function and long-term kidney transplant outcomes. Presented at: ATC2023, San Diego, California, June 3-7. Abstract A234.