Changes by Era in Risk Factors and Outcomes Among Deceased Donor Kidney Transplant Recipients With Delayed Graft Function

INTRODUCTION: There are no effective therapeutic agents for preventing or treating delayed graft function (DGF) among deceased donor kidney transplant recipients (DDKTRs). Donor and recipient factors are important to predicting DGF and associated outcomes, which we hypothesize differed over time. METHODS: DDKTRs were stratified by transplant year into four eras-E1 (2000-2005), E2 (2006-2011), E3 (2012-2017), and E4 (2018-2021). We analyzed risk factors for DGF, along with one-year uncensored graft failure (UCGF), death-censored graft failure (DCGF), death with a functioning graft (DWFG), and acute rejection (AR) by era. RESULTS: A total of 3085 DDKTRs were included (E1: 804, E2: 882, E3: 909, E4: 490). The proportion of patients with DGF differed significantly by era. Duration of DGF and median dialysis count were lower in recent eras. In E1-E4, donation after circulatory death, higher donor terminal serum creatinine, and pretransplant duration of dialysis were risk factors for DGF, while preemptive transplant was associated with lower odds of DGF. Other factors were not consistently associated with DGF across eras. The risk of one-year AR was significantly lower in E3 (aHR: 0.46; 95% CI: 0.30-0.69, p < 0.001) and E4 (aHR: 0.16; 95% CI: 0.07-0.36, p < 0.001) compared to E1. There were trends towards decreased risk for UCGF and DWFG in E2, E3, and E4. CONCLUSION: Some risk factors for DGF remained consistent, while others differed. Likely due to improved management, the risk for AR in the DGF setting improved in recent eras. There were trends of improved uncensored graft and patient survival in recent eras.