Presentation Authors: Da David Jiang*, John Barry, David Scott, Portland, OR
Introduction: Delayed graft function (DGF) is defined as the need for dialysis in the first week following kidney transplant. Nationally about 26% of kidney recipients have DGF. DGF is an important metric; it has been shown be strongly associated with increased costs of transplantation and is a convenient metric for deceased donor intervention studies. Most cases of DGF are thought to be caused by ischemic-reperfusion injury but recipient conditions such as rejection or recurrence may also play a role. Our goal is to determine rates of DGF at OHSU and find donor, recipient and other factors that may be associated with increased DGF.
Methods: Deceased donor kidney transplants performed at OHSU were retrospectively reviewed from 1/1/2012â€“12/31/2016. Data tables were generated from the OHSU transplant Datamart, which contains key data elements for each OHSU kidney transplant. Additional data elements were integrated from the UNOSâ€™s Review of Organ offers report which provides additional data about the organ donor and non-identifiable outcomes of other transplants from the same donor. The incidence of DGF was calculated; univariate and multivariate analysis were performed on recipient, donor, and other variables. Chart review was performed on cases with DGF to identify possible recipient causes.
Results: Between 1/1/2012â€“12/31/2016, 326 patients received deceased donor kidney transplants at OHSU. The overall number of DGF was 31 (9.5%). The rate of DGF decreased from 20.8% in 2012 to 2.7% in 2016. Univariate analysis revealed that male sex, donation after circulatory death (DCD), DGF in the mate kidney, increased donor age, higher KDPI, cold ischemia time, and earlier transplant year were associated with increased risk of DGF. On multivariate analysis, DCD, KDPI, DGF in the mate kidney, cold ischemia time >15hrs, pulsatile perfusion were associated with increased risk of DGF. In the 31 patients that had DGF, recipient causes such as myocardial infarction, severe perioperative hypotension, cardiac arrhythmia, simultaneous heart transplant, vascular complications, rejection, and recurrence of disease accounted for 11 of the 31 (35%) patients with DGF.
Conclusions: Rates of DGF in deceased donor kidney transplant at OHSU are lower than rates that are commonly reported. This may suggest that DGF rates may be modifiable through relatively simple interventions such as use of pulsatile perfusion or protocolled procurement. Recipient factors, especially cardiovascular hemodynamic status, may be responsible for DGF in about 3% of all transplants which may be represent an additional area for research and quality improvement.