Recipient risk factors associated with delayed graft function: A paired kidney analysis

Background. Delayed graft function (DGF) is a common complication of deceased donor kidney transplantation that occurs because of a complex interplay between donor organ quality and the biologic milieu of the recipient. The purpose of the study is to better understand the recipient risk factors leading to DGF. Methods. We performed a retrospective cohort study using United Network for Organ sharing data and identified pairs of primary, adult kidney-only transplants that were procured from the same adult donor with discordant occurrence of DGF (i.e., one kidney of the pair had DGF). Results. A total of 5382 recipient pairs were analyzed. Recipients with DGF were more likely to be male (67% vs. 59%, P<0.01), African American (36% vs. 27%, P<0.01), obese (30% vs. 19%, P<0.01), diabetic (28% vs. 22%, P<0.01), on maintenance dialysis (92% vs. 83%, P<0.01), and to have longer wait-time (571 vs. 471 days, P<0.01), longer cold ischemia time (22 vs. 20 hr, P<0.01), and donor and recipient size mismatch (32% vs. 24%, P<0.01). Multivariable analyses confirmed these associations and identified panel reactive antibody more than 10% and low center volume as additional risk factors for DGF (odds ratio for panel reactive antibody >10%: 1.17, confidence interval 1.05-1.29, P<0.01; and odds ratio for <83 transplants/year: 1.29, confidence interval 1.17-1.44, P<0.01). Conclusions. After fully matching for donor factors, many recipient characteristics were noted to be associated with DGF. Better management of modifiable recipient and transplant risk factors such as obesity, wait time, and cold time may help to reduce the occurrence of DGF.