Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the UK: a national cohort study.

Kidneys from donation after circulatory death (DCD) donors are utilized variably worldwide, in part due to high rates of delayed graft function (DGF) and putative associations with adverse longer-term outcomes. We aimed to determine whether the presence of DGF, and its duration, were associated with poor longer-term outcomes after kidney transplantation from DCD donors. Using the UK transplant registry, we identified 4714 kidney-only transplants from controlled DCD donors to adult recipients between 2006-2016; 2832 recipients (60·1%) had immediate graft function and 1882 (39.9%) had DGF. Of the 1847 recipients with DGF duration recorded, 926 (50·1%) had DGF 14 days. After risk adjustment, the presence of DGF was not associated with inferior long-term graft or patient survivals. However, DGF duration of >14 days was associated with an increased risk of death-censored graft failure (hazard ratio 1·7, p=0·001) and recipient death (hazard ratio 1·8, p 14 days is a novel early biomarker for significantly worse longer-term outcomes.