Delayed Graft Function Varies Between Transplantation Centers

Transplantation centers vary widely in their rates of delayed graft function (DGF) after deceased-donor kidney transplantation, reports a study in Transplantation.

The study used data on more than 82,000 patients receiving deceased-donor kidney transplants at centers in the US between 2003 and 2012, drawn from the Scientific Registry of Transplant Recipients. The association between center characteristics and DGF was assessed, with adjustment for identified patient risk factors.

Delayed graft function, defined as the need for dialysis during the first week after transplantation, occurred in 27.0 percent of patients. Across the 177 transplantation centers, DGF incidence ranged from 2.3 to 63.3 percent, with an interquartile range of 18.7 to 33.8 percent.

Center-level factors associated with a lower likelihood of DGF included the proportion of pre-emptive transplantations, odds ratio (OR) 0.83 per 5 percent increment; and percentage of kidneys with cold ischemia time of 30 hours or longer, OR 0.95 per 5 percent increment. Factors associated with more DGF were the center’s proportion of donation of cardiac death, OR 1.12 per 5 percent increment; and imported kidneys, OR 1.06 per 5 percent increment.

In a combined patient-level and center-level logistic model, 41.8 percent of centers had a DGF incidence in line with the national median. The predicted incidence was above the median for 28.2 percent of centers and below the median for 29.9 percent.

Although patient-level factors associated with DGF are well established, little is known about differences in DGF between transplantation centers. This study found significant variations in DGF between centers, even after adjustment for patient-level and center-level factors.

The authors note that their findings may reflect the subjective nature of the decision to begin dialysis in patients during the first week after transplantation [Orandi BJ, et al. Center-level variation in the development of delayed graft function after deceased donor kidney transplantation. Transplantation 2015; 99:997–1002].