A risk model incorporating delayed graft function, poor renal function recovery, and low estimated glomerular filtration rate (eGFR) in the 90 days after deceased-donor kidney transplantation improves predictions of long-term graft failure and death in recipients, investigators report.

Using delayed graft function alone for prognosis is not ideal, Shaifali Sandal, MD, of McGill University Health Centre in Montreal, Quebec, Canada, and colleagues explained. Each additional exposure criteria enhances risk prediction. Renal recovery and eGFR at 90 days better reflect, for example, non-recovery from ischemic-reperfusion injury in the explanted graft.

Among 792 recipients, the investigators found that 24.5% experienced delayed graft function, 40.5% had renal function recovery less than 100% (half the donor’s terminal eGFR, plus 15 if the transplant was pre-emptive) at 90 days, and 6.9% had an eGFR less than 30 mL/min/1.73 m2 at 90 days. Recipients were at no, low, moderate, or high risk if they met 0, 1, 2, or all 3 of the criteria, respectively.

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Over a median 7.3 years, death-censored graft failure occurred in 18.7% of recipients and mortality in 25.1%. The risk for death-censored graft failure was significantly increased 1.5-, 2.8-, and 15.5-fold in recipients with 1, 2, and 3 risk factors, respectively, compared with 0, the investigators reported in Kidney360. The risk for all-cause mortality was significantly increased 1.9- and 2.7-fold in recipients with 2 and 3 risk factors, respectively. The risk for developing stage 4 or higher chronic kidney disease within 5 years in patients with 2 and 3 risk factors was significantly increased 5.2- and 40.1-fold, respectively.

The investigators found similar non-significant trends in an external validation cohort at lower risk for graft failure due to younger age, less diabetes, fewer non-White patients, and fewer expanded criteria donors.

“Using a minimal and readily available set of variables, we can identify patients at the highest risk spectrum, which has therapeutic implications,” Dr Sandal’s team wrote.

The investigators could not account for early rejection after transplantation, which is a study limitation.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Sandal S, Cantarovich M, Cardinal H, et al. Predicting long-term outcomes in deceased donor kidney transplant recipients using three short-term graft characteristics. Kidney360. Published online May 22, 2023. doi:10.34067/KID.0000000000000154