Association between delayed graft function and allograft and patient survival: A systematic review and meta-analysis

Sri G. Yarlagadda, Steven G. Coca, Richard N. Formica, Emilio D. Poggio, Chirag R. Parikh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1039-1047
Number of pages9
JournalNephrology Dialysis Transplantation
Volume24
Issue number3
DOIs
StatePublished - Mar 1 2009

Keywords

  • Acute rejection
  • Acute tubular necrosis
  • Graft dysfunction
  • Renal function
  • Serum creatinine

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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