A. Christianson2, H. Kaul1, A. Parsikia1, N. Chandolias1, K. Khanmoradi1, R. Zaki1 1Einstein Medical Center Philadelphia, Now Part Of Jefferson Health, Philadelphia, PA, USA 2Philadelphia College of Osteopathic Medicine-Georgia Campus, Suwanee, GA, USA
Introduction: A Delayed graft function (DGF) occurs when dialysis is required within 1 week after transplantation. In primary transplant, DGF is associated with a 35% increase in likelihood of recurrence for kidney failure. There are a number of articles exploring the risk factors for primary DGF. However, current literature does not include many resources on the risk factors for DGF when it is a recipient’s second kidney transplant. We sought to study the second transplants that were complicated by DGF and link them to their primary transplant. By linking the primary and second transplants, we were able to compare the two procedures and identify risk factors for DGF when a patient is undergoing a second kidney transplant.
Methods: UNOS data from 1/2008-6/2021 was analyzed. Pancreas transplant, multi-organ transplants and living donors were excluded. Additionally, patients that were documented as lost-to-follow-up were removed. Second transplant patients with DGF were identified. On Uni-variate analysis the recipient and donor demographics, co-morbidities and transplant-related co-morbidities were compared separately for the primary and second transplant between patients with a second DGF vs. not. The univariate analysis was performed utilizing t-test and chi-squared test. The statistically significant risk factors were then selected to build a multivariate logistic regression model.
Results: After applying exclusion criteria, a total of 2964 second kidney transplants were identified. Rate of DGF in the second transplant was 28.4% (843/2964) and 49.2% of them had a prior DGF in their first transplant (p<0.001). History of graft loss due to acute/hyperacute rejection in the first transplant was higher among patients with re-transplant DGF (16.8% vs. 13.7%, p=0.037). The multivariate analysis confirmed that occurrence of DGF in the primary transplant (OR 1.5, p<0.001) and graft loss due to acute or hyperacute rejection (OR 1.2 p< 0.005) were predictors of re-appearing DGF in the second transplant.
Conclusion: This study shows that acute or hyperacute rejection as well as DGF in the first kidney transplant increases the possibility of DGF in the second transplant. Current literature predominantly focuses on risk factors for primary transplant DGF. With a limited number of donor kidneys available for transplant, it is imperative that all risk factors be identified and adjusted as much as possible in order to ensure the greatest chance for successful re-transplantation with minimal complications. DGF is thus not just related to the quality of the graft. This study opens the possibility of identifying additional risk factors for patients undergoing retransplant surgeries.
