B. Peticca1, T. Prudencio1, H. Majeethia1, S. Robinson1, C. Inlaw1, A. Di Carlo1, S. Karhadkar1 1Temple University, Surgery, Philadelpha, PA, USA
Introduction: In kidney transplantation (KT), it is widely known that delayed graft function (DGF), defined by a patient requiring dialysis within 1 week following transplantation, is associated with worsened outcomes. It is unclear as to what effect DGF plays in long-term survival compared to the effect of the various transplant, donor, and recipient risk factors that are associated with DGF. Few studies have explored DGF in a pediatric-only recipient population or where cases and controls have been propensity score matched for transplant, donor, and recipient risk factors for DGF. This study aims to determine the effect of DGF alone on long-term survival in a pediatric population.
Methods: Using United Network for Organ Sharing (UNOS) data, 1,222 pediatric patients under 18 years of age who received a kidney transplant between 1989 and 2009 were identified. Cases (n=611) and controls (n=611) were propensity score matched by DGF status with a match tolerance of 0.01 for donor type, cold ischemia time, distance from transplant center, HLA mismatch level, peak PRA, recipient and donor age, BMI, sex assigned at birth, and ethnicity. Categorical variables were compared between groups using a Pearson’s chi-square test. Numerical variables were compared using a nonparametric K test for independent samples. Patient and graft survival were analyzed using Kaplan-Meier curves with a log-rank test for significance. IBM SPSS Version 28 was used to analyze data.
Results:
Kaplan-Meier analysis showed pediatric KT recipients with DGF had worse graft (P <0.001) and patient (P <0.001) survival . Pediatric KT recipients with DGF experienced decreased median graft (3.32 vs. 7.36 yrs; P <0.001) and patient (6.79 vs 9.79 yrs; P <0.001) survival and an increased rate of retransplantation (41.2% vs. 29.8%; P <0.001). Graft survival rates were lower in the DGF cohort at 1 year (92.3% vs. 65.6%; P < 0.001), 3 years (77.7% vs. 51.2%; P < 0.001), 5 years (64.5% vs. 38.8%; P < 0.001), and 10 years (36.7% vs. 22.7%; P < 0.001).
Conclusion:Our study asserts that DGF alone is associated with poor graft and patient survival in pediatric KT recipients. Even when propensity score matched to control for transplant, donor, and recipient variables, DGF was associated with worse outcomes. We argue that DGF should be taken seriously, especially in cases where pediatric KT recipients do not possess the known, attributable risk factors for DGF.
