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KMID : 0361120210350030149
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Korean Journal of Transplantation
2021 Volume.35 No. 3 p.149 ~ p.160
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Impact of delayed graft function on clinical outcomes in highly sensitized patients after deceased-donor kidney transplantation
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Kim Seong-Gyu
Hong Su-Yeon
Lee Han-Bi
Eum Sang-Hun
Kim Young-Soo
Jin Kyu-Bok
Han Seung-Yeop
Yang Chul-Woo
Park Woo-Yeong
Chung Byung-Ha
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Abstract
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Background: We investigated whether the development of delayed graft function (DGF) in pre-sensitized patients affects the clinical outcomes after deceased-donor kidney transplantation (DDKT).
Methods: The study included 709 kidney transplant recipients (KTRs) from three transplant centers. We divided KTRs into four subgroups (highly sensitized DGF, highly sensitized non-DGF, low-sensitized DGF, and low-sensitized non-DGF) according to panel reactive antibody level of 50%, or DGF development. We compared post-transplant clinical outcomes among the four subgroups.
Results: Incidence of biopsy-proven acute rejection (BPAR) was higher in two highly sensitized subgroups than in low-sensitized subgroups. It tended to be higher in highly sensitized DGF subgroups than in the highly sensitized non-DGF subgroups. In addition, the highly sensitized DGF subgroup showed the highest risk for BPAR (hazard ratio, 3.051; P=0.005) and independently predicted BPAR. Allograft function was lower in the two DGF subgroups than in the non-DGF subgroup until one month after transplantation, but thereafter it was similar. Death-censored graft loss rates and patient mortality tended to be low when DGF developed, but it did not reach statistical significance.
Conclusions: DGF development in highly sensitized patients increases the risk for BPAR in DDKT compared with patients without DGF, suggesting the need for strict monitoring and management of such cases.
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KEYWORD
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Kidney transplantation, Delayed graft function, Sensitization, Graft loss, Acute rejection
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