# Delayed Graft Function and Its Duration as Predictors of Medium-Term Kidney Transplant Outcomes: A Retrospective Cohort Study from an Eastern European Center

## TL;DR

This study shows that delayed kidney transplant function, especially when lasting more than 14 days, is linked to worse long-term outcomes for both the transplanted kidney and the patient.

## Contribution

The study provides new insights into the prognostic value of prolonged delayed graft function duration in kidney transplant recipients from an Eastern European center.

## Key findings

- Delayed graft function occurred in 28.8% of patients and was linked to worse graft and patient survival.
- Patients with DGF lasting more than 14 days had the poorest outcomes.
- DGF was associated with higher BMI, comorbidities, and longer pre-transplant dialysis.

## Abstract

Background/Objectives: Delayed graft function (DGF) is a major complication after kidney transplantation, affecting graft and patient survival. Although well-studied in Western populations, data from Eastern Europe are limited, and the prognostic significance of DGF severity, particularly renal replacement therapy (RRT) duration, is not well-defined. Methods: We conducted a retrospective analysis of 479 adult recipients of brain-dead donor (DBD) kidney transplants at a high-volume transplant center in Romania (2017–2024). DGF was defined as the need for dialysis within seven days’ post-transplant. Baseline characteristics, graft function, and survival outcomes were compared between DGF and non-DGF groups. Kidney function was evaluated using the Estimated Glomerular Filtration Rate (eGFR). Patient and graft survival were assessed using Kaplan–Meier curves and log-rank tests. DGF severity was stratified by RRT duration (≤14 vs. >14 days). Results: DGF occurred in 28.8% of patients (adjusted 24%). Those with DGF had a higher Body Mass Index (BMI), greater comorbidity (Charlson Index, Estimated Post-Transplant Survival (EPTS) score), longer pre-transplant dialysis, and higher Kidney Donor Profile Index (KDPI) donor kidneys. DGF was associated with lower graft survival at one, three, and five years and reduced patient survival at three and five years. Longer RRT was associated with progressively worse outcomes, with the poorest prognosis in patients needing >14 days. Conclusions: Delayed graft function was significantly associated with reduced graft and patient survival. Prolonged DGF time was found to be predictive for poorer outcomes.