Factors associated with delayed graft function in kidney transplantation in IRAN

Kidney transplantation is a life-saving treatment for end-stage kidney disease (ESKD), but delayed graft function (DGF), remains a significant challenge, leading to poor patient outcomes. This study aimed to identify factors associated with DGF in kidney transplant recipients. This study was conducted on 271 non-sensitized first-time kidney transplant recipients aged over 18 years at Hasheminejad Hospital, Tehran, Iran, from 2022 to 2024. Demographics and clinical data were collected on recipients and donors, including comorbidities, immunosuppressive drugs, intraoperative hypotension, etc. Regression analysis with 95% confidence interval (CI) was performed and reporting as odds ratio (OR). Statistical data were analyzed using SPSS version 21 and the significant level was set at 0.05. Recipient-related factors associated with DGF included intraoperative hypotension (32.05% vs. 10.36%), absence of residual kidney function (20.99% vs. 10.09%), higher body mass index (BMI) (25.22 vs. 23.73 kg/m²), and longer cold ischemia time (CIT) (170 vs. 87 min) (all P < 0.05). Donor-related risk factors included deceased donor transplantation (32.14% vs. 9.63%), older donor age (39.16 vs. 34.52 years), higher donor damage score, and multiple donor renal arteries (all P < 0.05). In multivariable logistic regression, higher recipient BMI (OR = 1.12, 95% CI: 1.02–1.23), longer CIT (OR = 1.01, 95% CI: 1.00–1.01), and absence of residual kidney function (OR = 2.33, 95% CI: 1.08–5.02) remained independently associated with DGF (all P < 0.05). The findings of the present study demonstrated that higher recipient BMI, absence of residual kidney function, intraoperative hypotension, and multiple donor arteries were independently associated with DGF after multivariable adjustment, whereas the association with cold ischemia time was attenuated after accounting for confounding factors.