Impact of delayed graft function on clinical outcomes in highly sensitized patients after deceased-donor kidney transplantation

Seong Gyu Kim; Suyeon Hong; Hanbi Lee; Sang Hun Eum; Young Soo Kim; Kyubok Jin; Seungyeop Han; Chul Woo Yang; Woo Yeong Park; Byung Ha Chung

doi:10.4285/kjt.21.0014

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Korean J Transplant 2021; 35(3): 149-160

Published online September 30, 2021

https://doi.org/10.4285/kjt.21.0014

Impact of delayed graft function on clinical outcomes in highly sensitized patients after deceased-donor kidney transplantation

Seong Gyu Kim¹, Suyeon Hong^2,3, Hanbi Lee^2,3, Sang Hun Eum^2,3, Young Soo Kim⁴, Kyubok Jin⁵, Seungyeop Han⁵, Chul Woo Yang^2,3, Woo Yeong Park⁵, Byung Ha Chung^2,3

¹ Division of Nephrology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
² Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
³ Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
⁴ Division of Nephrology, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
⁵ Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea

Correspondence to: Byung Ha Chung
Department of Internal Medicine, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-6066
Fax: +82-2-536-0323
E-mail: chungbh@catholic.ac.kr

Woo Yeong Park
Department of Internal Medicine, Keimyung University Kidney Institute, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea
Tel: +82-53-250-7399
Fax: +82-53-253-7976
E-mail: parkwy2015@dsmc.or.kr

Received: July 22, 2021; Revised: September 18, 2021; Accepted: September 18, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

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.

Keywords: Kidney transplantation, Delayed graft function, Sensitization, Graft loss, Acute rejection

HIGHLIGHTS
The combination of high sensitization and delayed graft function (DGF) could increase the risk of biopsy-proven acute rejection, as the most important factor in allograft outcome, comparing with high sensitization or DGF alone. In highly sensitized patients before kidney transplant (KT), enhanced desensitization and strict monitoring after KT may be necessary to prevent DGF.