A SYSTEMATIC LITERATURE REVIEW (SLR) OF THE PREVALENCE, RISK FACTORS, AND SHORT- AND LONG-TERM IMPACT ON HEALTHCARE RESOURCE UTILIZATION (HCRU) OF DELAYED GRAFT FUNCTION (DGF) IN PATIENTS RECEIVING KIDNEY ALLOGRAFTS
Author(s)
Fiston Vuvu, PharmD, MS, Jinny Min, PharmD, Eli Khankin, MD, Mingyi Huang, PhD;
Apellis Pharmaceuticals, Inc, Waltham, MA, USA
Apellis Pharmaceuticals, Inc, Waltham, MA, USA
OBJECTIVES: DGF (dialysis within 7 days post transplant), has increased over time, with no new therapies to prevent occurrence. This SLR aimed to identify DGF prevalence, risk factors, and HCRU impact.
METHODS: In October 2025, we conducted an SLR per PRISMA guidelines based on literature searches, yielding ~1300 articles and ~1900 congress abstracts over the prior 10 years. Two independent medical writers evaluated articles for inclusion. This interim report summarizes their key findings.
RESULTS: To date, 424 articles were reviewed. DGF rates varied from 0-80%, primarily influenced by study conditions, specifically donor type. For instance, in the United States (US), DGF rates were often significantly lower for living donors (upper range ~8%) versus deceased donors (upper range >50%). DGF risk factors included use of deceased donor kidneys, especially from extended criteria donors or donors after circulatory death, prolonged cold ischemia times, and specific patient comorbidities (e.g., pulmonary hypertension). Various donor/recipient factors (e.g., age/sex/body mass index/dialysis duration prior to transplant/donor-specific antibodies) were identified as potential DGF predictors. However, multivariate analyses often diminished their predictive strength. The most consistent DGF predictors were type of donor (deceased versus living) and storage conditions. In many studies, DGF was associated with increased short- and long-term graft loss, early and long-term graft dysfunction, acute rejection, urinary tract infection, increased patient stress, prolonged hospitalization, and higher medical costs within the first year of transplant. To illustrate, in one retrospective study evaluating over 120,000 deceased donor kidney transplants in the US, DGF was significantly associated with increased hospital stay duration (median 9.2 vs 6.4 days).
CONCLUSIONS: DGF rates varied across studies, driven primarily by kidney donor type and associated parameters. When present, DGF could lead to lower graft survival and increased HCRU. Mitigating DGF risk remains an unmet need in the short term post kidney transplant.
METHODS: In October 2025, we conducted an SLR per PRISMA guidelines based on literature searches, yielding ~1300 articles and ~1900 congress abstracts over the prior 10 years. Two independent medical writers evaluated articles for inclusion. This interim report summarizes their key findings.
RESULTS: To date, 424 articles were reviewed. DGF rates varied from 0-80%, primarily influenced by study conditions, specifically donor type. For instance, in the United States (US), DGF rates were often significantly lower for living donors (upper range ~8%) versus deceased donors (upper range >50%). DGF risk factors included use of deceased donor kidneys, especially from extended criteria donors or donors after circulatory death, prolonged cold ischemia times, and specific patient comorbidities (e.g., pulmonary hypertension). Various donor/recipient factors (e.g., age/sex/body mass index/dialysis duration prior to transplant/donor-specific antibodies) were identified as potential DGF predictors. However, multivariate analyses often diminished their predictive strength. The most consistent DGF predictors were type of donor (deceased versus living) and storage conditions. In many studies, DGF was associated with increased short- and long-term graft loss, early and long-term graft dysfunction, acute rejection, urinary tract infection, increased patient stress, prolonged hospitalization, and higher medical costs within the first year of transplant. To illustrate, in one retrospective study evaluating over 120,000 deceased donor kidney transplants in the US, DGF was significantly associated with increased hospital stay duration (median 9.2 vs 6.4 days).
CONCLUSIONS: DGF rates varied across studies, driven primarily by kidney donor type and associated parameters. When present, DGF could lead to lower graft survival and increased HCRU. Mitigating DGF risk remains an unmet need in the short term post kidney transplant.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH75
Topic
Epidemiology & Public Health
Disease
SDC: Rare & Orphan Diseases