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Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)3346-3355
Number of pages10
JournalAmerican Journal of Transplantation
Issue number10
Early online date23 Mar 2021
Accepted/In press15 Mar 2021
E-pub ahead of print23 Mar 2021
PublishedOct 2021

Bibliographical note

Funding Information: The authors of this manuscript have conflicts of interest to disclose as described by the . Benedict L. Phillips’ salary was funded by a grant from Kidney Research UK. The salaries of Maria Ibrahim and George H. B. Greenhall were funded by fellowships from National Health Service Blood and Transplant. American Journal of Transplantation Publisher Copyright: © 2021 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Kidneys from donation after circulatory death (DCD) donors are utilized variably worldwide, in part due to high rates of delayed graft function (DGF) and putative associations with adverse longer-term outcomes. We aimed to determine whether the presence of DGF and its duration were associated with poor longer-term outcomes after kidney transplantation from DCD donors. Using the UK transplant registry, we identified 4714 kidney-only transplants from controlled DCD donors to adult recipients between 2006 and 2016; 2832 recipients (60·1%) had immediate graft function and 1882 (39·9%) had DGF. Of the 1847 recipients with DGF duration recorded, 926 (50·1%) had DGF < 7 days, 576 (31·2%) had DGF 7–14 days, and 345 (18·7%) had DGF >14 days. After risk adjustment, the presence of DGF was not associated with inferior long-term graft or patient survivals. However, DGF duration of >14 days was associated with an increased risk of death-censored graft failure (hazard ratio 1·7, p = ·001) and recipient death (hazard ratio 1·8, p < ·001) compared to grafts with immediate function. This study suggests that shorter periods of DGF have no adverse influence on graft or patient survival after DCD donor kidney transplantation and that DGF >14 days is a novel early biomarker for significantly worse longer-term outcomes.

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