Association between Slow and Delayed Graft Function with Graft Outcomes in Pediatric and Adolescent Deceased Donor Kidney Transplant Recipients

Background Delayed graft function (DGF) is associated with an increased risk of graft loss in adult kidney transplant recipients but the association remains inconsistent in pediatric recipients. The aim of this study is to examine the association between DGF and graft loss in pediatric and adolescent deceased donor kidney transplant recipients aged 21 years or younger using Australia and New Zealand Dialysis and Transplant registry. Methods The associations between DGF status, overall and death-censored graft loss (DCGL) were examined using adjusted Cox regression analyses. Results There were 367 recipients followed up for a median of 9.7 years between 1990 and 2012, with 82 (22%) experiencing DGF requiring dialysis (DGF-D) in the first 72 hours after transplant. Compared with recipients who did not experienced DGF-D, the adjusted hazard ratios for overall graft loss and DCGL in recipients who have experienced DGF-D was 2.08 (95% confidence interval [95% CI], 1.39-3.11; P < 0.001) and 2.09 (95% CI, 1.38-3.17; P < 0.001), respectively, independent of era, age, and initial immunosuppression. Slow graft function, defined as no immediate function but not requiring dialysis, was associated with adjusted hazard ratios of 2.60 (95% CI, 1.50-4.51; P = 0.001) for overall graft loss and 2.49 (95% CI, 1.39-4.47; P = 0.002) for DCGL. Conclusions This study has shown that DGF, encompassing a spectrum of renal dysfunction after kidney transplantation including those who may or may not require dialysis, is an independent risk factor for long-term graft loss.