Delayed Graft Function, Predictive Factors, and 7-Year Outcome of Deceased Donor Kidney Transplant Recipients With Different Immunologic Profiles.

BACKGROUND: Delayed graft function (DGF) is the major post-transplant cause of deleterious effects to the allograft and is associated with poor allograft survival. The aim of this study was to report the outcomes of 236 kidney transplant recipients with different immunologic profiles.

METHODS: All patients underwent transplantation (2008-2016) with a deceased donor at the University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil. Patients were classified into 3 groups according to immunologic profiles: nonsensitized (NS), sensitized without donor-specific antibody (SDSA-), or sensitized with donor-specific antibody (SDSA+).

RESULTS: DGF was observed in 128 (54.24%), including 63 (49.22%) NS, 51 (39.84%) SDSA-, and 14 (10.94%) SDSA+ patients. The development of DGF was associated with dialysis for ≥49.25 months (odds ratio [OR] 2.30), donor age ≥42.25 years (OR 1.77), donor end creatinine level >1.22 mg/dL (OR 1.94), and cold ischemia time >12 hours (OR 2.45). Of the 55 patients with rejections, 37 (15.68%) had T-cell-mediated rejection (TCMR) and 18 (7.63%) had antibody-mediated rejection (AMR). Nine patients (16.36%) exhibited graft loss, 2 (0.85%) via TCMR in the SDSA- DGF+ group and 7 (2.97%) via AMR, including 2 NS DGF-, 2 SDSA- DGF-, 1 SDSA- DGF+, and 2 SDSA+ DGF+ patients. Graft survival significantly differed between the NSDGF- and SDSA- DGF+ groups (P = .014) and between the NS DGF- and SDSA+ DGF- groups (P = .036).

CONCLUSION: In the 7-year period following transplantation, TCMR was more prevalent than AMR among patients with DGF. Graft loss was less prevalent among patients with TCMR than among those with AMR.