Stoy David, Muth Brenda, Astor Brad C, Mandelbrot Didier, Parajuli Sandesh
Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI, 4175 MFCB53705, USA.
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
J Nephrol. 2025 May;38(4):1183-1190. doi: 10.1007/s40620-024-02104-5. Epub 2024 Oct 3.
Delayed graft function (DGF) is a common complication and is associated with worse outcomes among kidney transplant recipients (KTRs). There are various risk factors for DGF including previous transplant. We hypothesized that DGF among KTRs undergoing repeat transplant has a greater impact on outcomes compared to primary KTRs.
All deceased-donor KTRs between 01/2000 and 12/2020 at our center were included. Recipients were categorized as primary KTR or repeat KTR (any number of previous kidney transplants). Outcomes of interest included acute rejection, death-censored graft failure, and patient mortality within 12 months post-transplant.
A total of 3137 deceased-donor KTRs were included; 2498(80%) were primary KTRs and 639(20%) were repeat KTRs. The rates of DGF were similar between the groups at 29% and 28%, respectively. Compared to KTRs without DGF, DGF was associated with a greater incidence of death and graft failure in both primary and repeat transplants; however, the risk of rejection was not significantly higher in repeat KTRs (p = 0.72). Comparing primary and repeat KTRs, there were no significant differences in either acute rejection (p-interaction = 0.11), death-censored graft failure (p-interaction = 0.38), or death (p-interaction = 0.37). In subgroup analysis among repeat KTRs with DGF, a repeat transplant with no prior DGF was associated with increased risk for death-censored graft failure and death but not for acute rejection. DGF in the prior transplant was protective against death-censored graft failure (HR: 0.07, 95% CI 0.005-0.98, p = 0.05) (p-interaction = 0.04), but this was not significantly associated with acute rejection or death.
DGF is associated with similar detrimental outcomes among primary and repeat KTRs.
移植肾功能延迟恢复（DGF）是一种常见并发症，与肾移植受者（KTRs）的不良预后相关。DGF存在多种风险因素，包括既往移植史。我们推测，接受再次移植的KTRs中DGF对预后的影响比初次移植的KTRs更大。
纳入2000年1月至2020年12月在本中心接受的所有死亡供者肾移植受者。受者分为初次KTR或再次KTR（有任何次数的既往肾移植史）。感兴趣的结局包括急性排斥反应、死亡截尾的移植失败以及移植后12个月内的患者死亡率。
共纳入3137例死亡供者肾移植受者；2498例（80%）为初次KTR，639例（20%）为再次KTR。两组的DGF发生率相似，分别为29%和28%。与未发生DGF的KTRs相比，DGF在初次和再次移植中均与更高的死亡和移植失败发生率相关；然而，再次KTRs中排斥反应的风险并未显著更高（p = 0.72）。比较初次和再次KTRs，急性排斥反应（p交互作用 = 0.11）、死亡截尾的移植失败（p交互作用 = 0.38）或死亡（p交互作用 = 0.37）均无显著差异。在发生DGF的再次KTRs亚组分析中，既往无DGF的再次移植与死亡截尾的移植失败和死亡风险增加相关，但与急性排斥反应无关。既往移植中的DGF对死亡截尾的移植失败具有保护作用（HR：0.07，95%CI 0.005 - 0.98，p = 0.05）（p交互作用 = 0.04），但这与急性排斥反应或死亡无显著关联。
DGF在初次和再次KTRs中均与类似的不良结局相关。
