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Abstract
The aim of this study is to investigate whether or not delayed graft function (DGF) and pre-transplant sensitization have synergistic adverse effects on allograft outcome after deceased donor kidney transplantation (DDKT) using the Korean Organ Transplantation Registry (KOTRY) database, the nationwide prospective cohort. The study included 1359 cases between May 2014 and June 2019. The cases were divided into 4 subgroups according to pre-sensitization and the development of DGF post-transplant [non-pre-sensitized-DGF(−) (n = 1097), non-pre-sensitized-DGF(+) (n = 127), pre-sensitized-DGF(−) (n = 116), and pre-sensitized-DGF(+) (n = 19)]. We compared the incidence of biopsy-proven allograft rejection (BPAR), time-related change in allograft function, allograft or patient survival, and post-transplant complications across 4 subgroups. The incidence of acute antibody-mediated rejection (ABMR) was significantly higher in the pre-sensitized-DGF(+) subgroup than in other 3 subgroups. In addition, multivariable cox regression analysis demonstrated that pre-sensitization combined with DGF is an independent risk factor for the development of acute ABMR (hazard ratio 4.855, 95% confidence interval 1.499–15.727). Moreover, DGF and pre-sensitization showed significant interaction (p-value for interaction = 0.008). Pre-sensitization combined with DGF did not show significant impact on allograft function, and allograft or patient survival. In conclusion, the combination of pre-sensitization and DGF showed significant synergistic interaction on the development of allograft rejection after DDKT.
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1 Seoul St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Seoul, South Korea (GRID:grid.414966.8) (ISNI:0000 0004 0647 5752)
2 Seoul St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Seoul, South Korea (GRID:grid.414966.8) (ISNI:0000 0004 0647 5752); Konyang University Hospital, College of Medicine, Konyang University, Division of Nephrology, Department of Internal Medicine, Daejeon, Republic of Korea (GRID:grid.411127.0) (ISNI:0000 0004 0618 6707)
3 Eunpyeong St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Seoul, South Korea (GRID:grid.414966.8) (ISNI:0000 0004 0647 5752)
4 Pusan National University Hospital, Organ Transplantation Center and Department of Internal Medicine, Busan, South Korea (GRID:grid.412588.2) (ISNI:0000 0000 8611 7824)
5 Ewha Womans University Medical Center, Department of Surgery, Seoul, South Korea (GRID:grid.411076.5)
6 Seoul National University Hospital, Department of Nephrology, Seoul, South Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X)
7 BHS Hanseo Hospital, Department of Nephrology, Busan, South Korea (GRID:grid.414966.8)
8 Han Yang University, Department of Surgery, College of Medicine, Seoul, South Korea (GRID:grid.414966.8)
9 Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Department of Surgery, Wonju-si, South Korea (GRID:grid.15444.30) (ISNI:0000 0004 0470 5454)
10 Korea University Anam Hospital, Department of Transplantation and Vascular Surgery, Seoul, South Korea (GRID:grid.411134.2) (ISNI:0000 0004 0474 0479)
11 Inje University Busan Paik Hospital, Department of Internal Medicine, Busan, South Korea (GRID:grid.411625.5) (ISNI:0000 0004 0647 1102)
12 Bongseng Memorial Hospital, Department of Internal Medicine, Busan, South Korea (GRID:grid.414550.1) (ISNI:0000 0004 0647 985X)
13 Kyungpook National University Hospital, Department of Internal Medicine, School of Medicine, Daegu, South Korea (GRID:grid.411235.0) (ISNI:0000 0004 0647 192X)
14 Bucheon St. Mary’s Hospital, Division of Nephrology, Department of Internal Medicine, Bucheon, South Korea (GRID:grid.414678.8) (ISNI:0000 0004 0604 7838)
15 Chonbuk National University Medical School, Department of Internal Medicine, Jeonju, South Korea (GRID:grid.411545.0) (ISNI:0000 0004 0470 4320)
16 Gachon University College of Medicine, Department of Surgery, Gil Medical Center, Seongnam, South Korea (GRID:grid.256155.0) (ISNI:0000 0004 0647 2973)
17 Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Surgery, Seoul, South Korea (GRID:grid.414964.a) (ISNI:0000 0001 0640 5613)
18 Konkuk University School of Medicine, Department of Nephrology, Seoul, South Korea (GRID:grid.258676.8) (ISNI:0000 0004 0532 8339)
19 Yeungnam University Hospital, Department of Nephrology, Daegu, South Korea (GRID:grid.413040.2) (ISNI:0000 0004 0570 1914)
20 Kosin University College of Medicine, Division of Nephrology, Department of Internal Medicine, Busan, South Korea (GRID:grid.411144.5) (ISNI:0000 0004 0532 9454)
21 Incheon St. Mary’s Hospital, Department of Internal Medicine, Incheon, South Korea (GRID:grid.464585.e) (ISNI:0000 0004 0371 5685)
22 Chungnam National University Hospital, Department of Nephrology, Daejeon, South Korea (GRID:grid.411665.1) (ISNI:0000 0004 0647 2279)
23 Maryknoll Medical Center, Division of Nephrology, Department of Internal Medicine, Busan, South Korea (GRID:grid.416490.e) (ISNI:0000 0004 1794 4665)
24 Pusan National University School of Medicine, Division of Nephrology, Department of Internal Medicine, Busan, South Korea (GRID:grid.262229.f) (ISNI:0000 0001 0719 8572)
25 Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Department of Surgery, Chuncheon, South Korea (GRID:grid.256753.0) (ISNI:0000 0004 0470 5964)
26 Kyung Hee University Hospital at Gangdong, Department of Nephrology, Seoul, South Korea (GRID:grid.496794.1)
27 Ajou University School of Medicine, Department of Surgery, Suwon, South Korea (GRID:grid.251916.8) (ISNI:0000 0004 0532 3933)
28 CHA Bundang Medical Center, Department of Surgery, Seongnam, South Korea (GRID:grid.452398.1) (ISNI:0000 0004 0570 1076)
29 SNU Boramae Medical Center, Department of Nephrology, Seoul, South Korea (GRID:grid.412479.d)
30 Myongji Hospital, Department of Surgery, Goyang, South Korea (GRID:grid.416355.0) (ISNI:0000 0004 0475 0976)
31 Soonchunhyang University Seoul Hospital, Department of Internal Medicine, Seoul, South Korea (GRID:grid.412678.e) (ISNI:0000 0004 0634 1623)
32 Inje University Ilsan Paik Hospital, Department of Surgery, Goyang, South Korea (GRID:grid.411633.2) (ISNI:0000 0004 0371 8173)
33 Kyung Hee University College of Medicine, Department of Internal Medicine, Seoul, South Korea (GRID:grid.289247.2) (ISNI:0000 0001 2171 7818)
34 Ewha Womans University Mokdong Hospital, Department of Surgery, Seoul, South Korea (GRID:grid.411076.5)
35 Ulsan University Hospital, Department of Surgery, Ulsan, South Korea (GRID:grid.412830.c) (ISNI:0000 0004 0647 7248)
36 Gangnam Severance Hospital, Yonsei University College of Medicine, Department of Surgery, Seoul, South Korea (GRID:grid.459553.b) (ISNI:0000 0004 0647 8021)
37 Seoul National University Bundang Hospital, Division of Nephrology, Seongnam, South Korea (GRID:grid.412480.b) (ISNI:0000 0004 0647 3378)
38 Chonnam National University Medical School, Department of Surgery, Gwangju, South Korea (GRID:grid.14005.30) (ISNI:0000 0001 0356 9399)
39 Asan Medical Center, Department of Surgery, Seoul, South Korea (GRID:grid.413967.e) (ISNI:0000 0001 0842 2126)
40 Keimyung University School of Medicine, Department of Internal Medicine, Daegu, South Korea (GRID:grid.412091.f) (ISNI:0000 0001 0669 3109)
41 Severance Hospital, Department of Transplantation Surgery, Seoul, South Korea (GRID:grid.415562.1) (ISNI:0000 0004 0636 3064)