Predictors of Delayed Graft Function in Living and Deceased Donor Kidney Transplantation: A Single-Centre Retrospective Cohort Study from India

Introduction: Delayed graft function (DGF) remains a common early complication, particularly after deceased donor kidney transplantation (DDKT). We sought to identify predictors in an Indian centre. Methods: We retrospectively analysed 324 consecutive transplants (living donor 174; deceased donor 150) performed between 2021 and 2023. The primary endpoint was DGF, defined as dialysis within seven postoperative days. Patient characteristics were compared using appropriate parametric or non-parametric tests after normality assessment. Multivariable logistic regression identified independent predictors. Results: Early graft function categories were as follows: living donor kidney transplantation – immediate graft function (IGF) 159/174 (91.4%), DGF 15/174 (8.6%); DDKT – IGF 81/150 (54.0%), DGF 69/150 (46.0%). Independent predictors of early dysfunction included higher donor terminal creatinine, extended criteria donor status, recipient diabetes, higher HLA mismatch, perioperative hypotension, and longer cold ischaemia time (CIT). Conclusion: Among largely non-modifiable donor factors, CIT, and perioperative haemodynamics emerged as actionable risk factors for early graft dysfunction, especially in deceased donor recipients. Targeted intraoperative monitoring and streamlined organ allocation pathways may mitigate these risks.