Effect of prolonged delayed graft function on long‐term graft outcome in cadaveric kidney transplantation

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Abstract
One‐hundred‐and‐twenty‐six cadaveric renal transplantations were analyzed for the effect of post‐transplant renal function on graft outcome. Thirty‐one grafts functioned immediately after transplantation (Group 1), 54 grafts failed to function temporarily up to 8 posttransplant days as evidenced by urine output 8 days (Group 3) and 8 grafts never functioned (group 4). Five‐year graft failure rates were 6.5% (2/31), 13.0% (7/54). 42.4% (14/33) and 100% (8/8) for Groups 1. 2, 3 and 4, respectively. Actuarial 5‐year graft survivals were 89.4%. 84.8%. 50% and 0% for Groups 1. 2, 3 and 4, respectively (p<0.05). The most common cause of graft failure was the chronic rejection in 13, of which 9 were in Group 3. Acute rejection episodes during the first 3 months post‐transplant in Group 3 (15 of 33, 45.5%) was slightly higher than that in Group 1 (10 of 30. 33.3%) or Group 2 (19 of 54. 35.2%) but the differences were not significant. Acute rejection episodes were associated with graft loss only 1 of 19 (5.3%) patients in Group 2 whereas 9 of 15 (47.4%) were seen in Group 3. The authors conclude that prolonged DGF is associated with a higher incidence of graft failure, particularly secondary to chronic rejection after 1 year posttransplant. Moreover, acute rejection based on prolonged DGF probably plays a major role in the development of chronic rejection.