Steroid avoidance or early withdrawal might therefore help with diabetic control in the crucial recovery period. Irish et al[8,9] formulated a predictive model of DGF by performing a multivariable logistic regression analysis of 24337 deceased donor transplant recipients in the United States. and 67.8% compared with 81.3% and 75.3% in the PGF group, = 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group SN 2 with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis vintage. CONCLUSION Alemtuzumab SN 2 induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF. = 135 (%)PGF = 292 (%)value 0.1 ST6GAL1 on univariant analysis were included in the multivariable analysis using a stepwise method selection. A value of 0.05 was deemed statistically significant. RESULTS The 135/427 (31.6%) of recipients of a deceased donor renal allograft experienced DGF. Patient and allograft outcomes were compared between the DGF and PGF (primary graft function) group, with a mean follow up was 42.62 19.96 mo. Patient survival Patient survival was negatively impacted by the development of DGF post-transplant. Overall patient survival at 1, 3 and 5 years post-transplant was 96.3%, 87.2% and 82.5% in the DGF group and 97.9%, 95.0% and 94.2% in the PGF group, 0.01 as shown in Figure ?Figure1A.1A. Censoring at the time of allograft failure, 1, 3 and 5 year patient survival was 98.4%, 90.2% and 87.2% in the DGF group and 97.9%, 95.7% and 94.9%, = 0.047 in the PFG as shown in Figure ?Figure1B.1B. The causes of death in the 11/135 (8.1%) DGF patients who died with a functioning graft were cardiovascular 4/11 (36.4%), sepsis 4/11 (36.4%), malignancy 1/11 (9.1%), autoimmune disease 1/11 (9.1%) and unknown 1/11 (9.1%). Open in a separate window Figure 1 Patient survival in patients with delayed graft function. SN 2 The 1, 3 and 5 year patient survival post-transplant: A: Overall patient survival: 96.3%, 87.2% and 82.5% in the DGF group and 97.9%, 95.0% and 94.2% in the PGF group, 0.01; B: Patient survival censored at the time of allograft failure: 98.4%, 90.2% and SN 2 87.2% in the DGF group and 97.9%, 95.7% and 94.9%, = 0.047. DGF: Delayed graft function; PGF: Primary graft function. Allograft outcomes Allograft survival was also inferior in the DGF group. Censored allograft survival in the DGF group was 90.3%, 84.7% and 77.9% at 1, 3 and 5 years compared with 99.0%, 95.5% and 90.2% in the PGF group, 0.001 as shown in Figure ?Figure2.2. The causes of allograft failure in the SN 2 23/135 (17.0%) of patients with DGF were late technical losses in 4/23 (17.4%) (2 renal vein thrombosis, 2 ureteric complications), rejection in 6/23 (26.1%), BK nephropathy in 1/23 (4.3%), progressive scarring in 6/23 (26.1%) and multifactorial aetiologies in 6/23 (26.1%). Open in a separate window Figure 2 Censored allograft survival. Censored allograft survival in the DGF group was 90.3%, 84.7% and 77.9% at 1, 3 and 5 years compared with 99.0%, 95.5% and 90.2% in the PGF group, 0.001. DGF: Delayed graft function; PGF: Primary graft function. The development of DGF but not donor type impacted on allograft survival. Overall allograft survival in recipients of DBD and DCD kidneys with PGF was 90.3% and 90.7% respectively, which was significantly higher than recipients of DBD and DCD kidneys with DGF, which was 75.3% and 65.8% respectively, = 0.0016 as shown in Figure ?Figure3.3. Comparing outcome by donor type, there was no difference in survival between DBD and DCD kidneys with PGF, = 0.84 or with independently, DBD and DCD kidneys with DGF, = 0.73. Open in a separate window Figure 3 Allograft survival by donor type and delayed graft function. Allograft survival in the DBD and DCD donors with PGF was significantly higher than the recipients of DBD and DCD kidneys with DGF, with an allograft survival of 90.3%, 90.7%, 75.3% and 65.8% respectively, = 0.0016. DGF:.