NDT Advance Access originally published online on December 22, 2008
Nephrology Dialysis Transplantation 2009 24(3):1039-1047; doi:10.1093/ndt/gfn667
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Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis
1 Section of Nephrology, University of Kansas Medical Center, Kansas City, KS 2 Section of Nephrology and Clinical Epidemiology Research Center, Yale School of Medicine and VAMC, New Haven, CT 3 Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH, USA
Correspondence and offprint requests to: Chirag R. Parikh, Section of Nephrology, Yale University and VAMC, 950 Campbell Ave, Mail Code 151B, Bldg 35 A, Room 219, West Haven, CT 06516, USA. Tel: +1-203-932-5711, Ext. 4300; Fax: +1-203-937-4932; E-mail: Chirag.parikh{at}yale.edu
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Abstract |
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Background. Delayed graft function (DGF) is a common complication of renal transplantation. The short-term consequences of DGF are well known, but the long-term relationship between DGF and patient and graft survival is controversial in the published literature. We conducted a systematic review and meta-analysis to precisely estimate these relationships.
Methods. We performed a literature search for original studies published through March 2007 pertaining to long-term (>6 months) outcomes of DGF. The primary outcome was graft survival. Secondary outcomes were patient survival, acute rejection and kidney function.
Results. When compared to patients without DGF, patients with DGF had a 41% increased risk of graft loss (RR 1.41, 95% CI 1.27–1.56) at 3.2 years of follow-up. There was no significant relationship between DGF and patient survival at 5 years (RR 1.14, 95% CI 0.94–1.39). The mean creatinine in the non-DGF group was 1.6 mg/dl. Patients with DGF had a higher mean serum creatinine (0.66 mg/dl, 95% CI 0.57–0.74) compared to patients without DGF at 3.5 years of follow-up. DGF was associated with a 38% relative increase in the risk of acute rejection (RR 1.38, 95% CI 1.29–1.47).
Conclusion. The results of this meta-analysis emphasize and quantify the long-term detrimental association between DGF and important graft outcomes like graft survival, acute rejection and renal function. Efforts to prevent and treat DGF should be aggressively investigated in order to improve graft survival given the deficit in the number of kidney donors.
Keywords: acute rejection; acute tubular necrosis; graft dysfunction; renal function; serum creatinine
Received for publication: 29. 7.08
Accepted in revised form: 5.11.08