Korean J Transplant.  2023 Nov;37(Suppl 1):S213. 10.4285/ATW2023.F-8034.

Delayed graft function in living donor kidney transplantation: exploring risk factors and impact on short- and long-term outcomes

• Koo B
• Kang M
• Koh H
• Kim HJ
• Kim HW
• Yang J
• Kim BS
• Huh KH
• Kim MS
• Lee J

• KMID: 2551833
• DOI: http://doi.org/10.4285/ATW2023.F-8034

Abstract

Delayed graft function (DGF) is a common complication in deceased donor kidney transplantation and is associated with worse outcomes. In contrast, DGF in living donor kidney transplantation (LDKT) has received less attention, particularly in the context of recipients with varying immunological risk profiles. We aimed to evaluate the risk factors for DGF and investigate the associations between DGF and both short- and long-term outcomes in LDKT recipients. A retrospective analysis was conducted on adult LDKT patients at Severance Hospital between 2006 and 2020. Among the 1,595 recipients in the study, 149 underwent human leukocyte antigen (HLA)-incompatible LDKT (including 32 with both HLA and ABO incompatibility), and 251 underwent ABO-incompatible LDKT. A total of 99 recipients (6.2%) experienced DGF. Multivariable analysis revealed several independent risk factors for DGF, including HLA incompatibility (odds ratio [OR], 5.52; 95% confidence interval [CI], 3.32–9.18), ABO incompatibility (OR, 4.35; 95% CI, 2.79–6.78), right-sided donor kidney (OR, 3.57; 95% CI, 2.08–9.18), and pre-transplant diabetes mellitus (OR, 1.79; 95% CI, 1.15–2.78). Throughout the follow-up period, 168 patients (10.5%) experienced death-censored graft loss, and 76 patients (4.8%) died. DGF was independently associated with death-censored graft loss (hazard ratio, 2.67; 95% CI, 1.66–4.28). Furthermore, DGF was associated with an elevated risk of hospital readmission within 1-year posttransplant and worse renal function at 1 year. Overall patient survival rates were comparable between the two groups. In conclusion, although the incidence of DGF is lower in LDKT, its impact remains significant. The occurrence of DGF in LDKT highlights the importance of considering immunological risk factors.