pISSN 2671-8790 eISSN 2671-8804

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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

© The Korean Society for Transplantation

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

Seong Gyu Kim1 , Suyeon Hong2,3 , Hanbi Lee2,3 , Sang Hun Eum2,3 , Young Soo Kim4 , Kyubok Jin5 , Seungyeop Han5 , Chul Woo Yang2,3 , Woo Yeong Park5 , Byung Ha Chung2,3

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

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.