Abstract
BACKGROUND: Reduced functional status (RFS) has been associated with death and graft loss after kidney transplant; whether the risk of short-term outcomes, including delayed graft function (DGF) and early graft loss (EGL) is also increased is unknown. The purpose of this study was to examine whether RFS is associated with DGF, EGL, and all-cause graft loss (ACGL) in kidney transplant recipients (KTRs; overall and by recipient age, sex, race, donor status, and transplant era). METHODS: Separately among adult living and deceased donor KTR in the United States identified using the SRTR (2000-2017), multivariable logistic regression and Cox proportional hazards models were used as appropriate to examine the association of RFS (Karnofsky Performance Status [KPS] ≤50%; requires considerable or greater assistance) relative to functional independence (KPS 80%-100%) at the time of kidney transplant with the outcomes of DGF, EGL, and ACGL. Whether recipient age, sex, race, donor status, or transplant era modified the risk of RFS associated with each outcome was also examined. RESULTS: Among 245 446 KTR, RFS at transplant was associated with increased risk of DGF (aOR 1.47, 95% CI 1.36-1.59), EGL (aOR 2.85, 95% CI 2.52-3.24), and ACGL (aHR 1.21, 95% CI 1.14-1.28) in deceased donor KTR, and increased risk of DGF (aOR 1.32, 95% CI 1.01-1.73), EGL (aOR 2.07, 95% CI 1.48-2.89), and ACGL (aHR 1.24, 95% CI 1.11-1.38) in living donor KTR compared to those with functional independence. In deceased donor KTR, the risk of DGF was modified by recipient age, sex, and race, and the risk of EGL was modified by sex. In living donor KTR, the risk of DGF was modified by age, and the risk of ACGL was modified by sex. CONCLUSIONS: RFS at transplant has increased over time and is associated with increased risk of DGF, EGL, and ACGL; recipient characteristics modify these risks.