Impact of early suboptimal graft function in deceased donor kidney transplantation: 10-year outcomes

Results from a single-center, retrospective study evaluating the impact of suboptimal graft function (SGF) on outcomes in recipients of deceased donor kidney transplants (DDKT) between February 2006 and January 2014 were published in Transplantation Proceedings by Mok et al. SGF was defined as a nadir serum creatinine >1.5 mg/dL within the first month post-transplant; a nadir serum creatinine ≤1.5 mg/dL was classified as standard graft function. The primary outcomes were 10-year graft and patient survival. 

Key data: Graft survival was lower in patients with SGF (n = 64) vs those with standard graft function (n = 230) at 5 years (82.3% vs 92.7%) and 10 years (63.2% vs 89.1%; p < 0.0001). In contrast, graft survival at 10 years was comparable in patients with delayed graft function (DGF) vs those without (76.5% vs 84.6%; p = 0.11). Recipients of grafts from donors aged ≥60 years had lower estimated 5-year (71.4% vs 92.8%) and 10-year graft survival (62.4% vs 86.6%; p < 0.0001) than those receiving grafts from donors aged <60 years. Patient survival did not differ between patients with SGF vs those with standard graft function at 5 years (100% vs 94.8%) or 10 years (89.0% vs 91.0%; p = 0.47). 

Key learning: In this study, SGF within the first month after DDKT was associated with worse 10-year graft survival but not patient survival vs standard graft function, while donor age ≥60 years was associated with worse graft survival vs donor age <60 years. These findings highlight the potential prognostic value of early post-transplant renal function and donor characteristics for long-term graft outcomes in DDKT.