Delayed Graft Function: More Than Just a Kidney Transplant Complication?

OBJECTIVES: Delayed graft function (DGF) lacks a universal definition but commonly refers to acute kidney injury (AKI) within the first week post-transplant requiring dialysis. The lack of clinical guidelines and approved treatment highlights the challenge of DGF management. This review aims to highlight the disease burden of DGF including epidemiology, clinical, humanistic, and economic outcomes, and identify unmet needs and gaps in current knowledge.

METHODS: A targeted literature search was conducted to identify relevant papers published between January 2013 and August 2023 in the following scope markets: US, UK, Germany, France, China, and Japan.

RESULTS: DGF occurs in approximately 24% of adult kidney transplant recipients but is less common in pediatric patients. Higher rates are linked to donor/recipient characteristics, such as donation after circulatory death (DCD), AKI donor allografts, and longer cold ischemia times. Adult 1-year graft survival is ~96%, while pediatric rates are lower at 89%, suggesting an unmet need in this population. Specific donor characteristics, such as AKI, time from transplant, and treatment in a non-specialized center, correlate with decreased graft survival and increased graft loss. Extensive dialysis within 7 days post-transplantation negatively impacts 10-year graft survival. Adult 1-year mortality ranges from ~2% to 8%. The humanistic burden of DGF is uncharacterized. Collection of health-related quality of life data is likely to be a key requirement for payers, given that these patients are on dialysis. There is also an absence of comprehensive economic data across markets, which hinders the ability to accurately characterize the economic burden of DGF.

CONCLUSIONS: The absence of clinical guidelines and approved treatments alongside some notable gaps in data, particularly in the humanistic and economic impact of DGF, emphasize the need for additional research to better inform treatment strategies and support payer decisions.