Delayed Graft Function and Its Impact on Short- and Long-Term Outcomes After Kidney Transplantation

Abstract Introduction: Kidney transplantation is an effective treatment for end-stage renal disease, markedly improving survival and quality of life. However, delayed graft function (DGF) remains a notable early post-transplant complication. This study aims to determine the impact of DGF on mortality, hypertension, graft survival, and other post-transplant complications. Methods This retrospective study included adult recipients (≥ 18 years) who underwent kidney transplantation at the Organ Transplant Unit of Diyarbakır Gazi Yaşargil Training and Research Hospital between 1 January 2013 and 31 December 2023. A total of 285 patients with at least 12 months of follow-up were analyzed. Demographic characteristics, presence of post-transplant hypertension, immunosuppressive regimens, and laboratory parameters related to graft function were extracted from the Hospital Information Management System (HIMS) using a standardized abstraction form. Post-transplant hypertension was defined according to the KDIGO 2021 guideline; details of the analytic approach are described in the Statistics section. Results In this cohort of 285 kidney transplant recipients, DGF occurred significantly more often following deceased-donor transplantation (p < 0.001) and was associated with inferior short- and long-term outcomes. Patients with DGF had markedly lower eGFR at discharge (p < 0.001), with differences persisting at the 3rd month (p = 0.045), 6th month (p = 0.030), 3rd year (p = 0.041), and 6th year (p = 0.027). Postoperative complications, particularly bleeding, were more frequent in the DGF group (p = 0.003 and p < 0.01, respectively), and mortality was significantly higher among patients with DGF (p < 0.001). In multivariate analysis, serum creatinine (p = 0.001) and urine protein levels (p = 0.001) at discharge remained independent predictors of DGF, whereas demographic and pre-transplant variables were not. Conclusion DGF significantly compromises both short- and long-term outcomes after kidney transplantation. Its strong association with deceased donation, early graft injury, and persistently reduced GFR highlights the importance of early identification and vigilant post-transplant management to improve graft and patient survival.