{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T01:00:36Z","timestamp":1774314036409,"version":"3.50.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplantation"],"published-print":{"date-parts":[[2019,2]]},"abstract":"\n Background<\/jats:title>\n Prolonged duration of delayed graft function (DGF) may be associated with adverse allograft outcomes, but the association between threshold duration of DGF, acute rejection and long-term allograft loss remains undefined. We aimed to determine the impact of DGF duration on allograft outcomes and to assess whether this association was mediated by acute rejection.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using data from the Australian and New Zealand Dialysis and Transplant Registry, Cox proportional modeling was used to determine the association between quartiles of DGF duration, acute rejection at 6 months and death-censored graft loss (DCGL). Mediation analysis was conducted to determine whether acute rejection was a causal intermediate between DGF and DCGL.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 7668 deceased donor kidney transplants between 1997 and 2014, 1497 (19.5%) recipients experienced DGF requiring dialysis. The median (interquartile range) duration of DGF was 7 (9) days, with 25% requiring dialysis for 14 days or longer. Among recipients who had experienced a DGF duration of 1 to 4 days, the adjusted hazard ratio for duration of 5 to 7, 8 to 13, and 14 days or longer were 1.13 (95% confidence interval [CI], 0.83-1.55; P<\/jats:italic> = 0.43), 1.44 (95% CI, 1.08-1.91; P<\/jats:italic> = 0.013), and 1.99 (95% CI, 1.50-2.65; P<\/jats:italic> < 0.001), respectively, for acute rejection; and were 1.10 (95% CI< 0.73-1.67; P<\/jats:italic> = 0.64), 1.45 (95% CI, 1.00-2.11; P<\/jats:italic> = 0.05) and 1.60 (95% CI, 1.10-2.31; P<\/jats:italic> = 0.01), respectively, for DCGL. On average, 8% of the effects between DGF duration and DCGL were explained by acute rejection.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n There was a direct dose-dependent effect between DGF duration and DCGL, with acute rejection explaining less than 10% of the effects between DGF duration and DCGL. Future research identifying other potential modifiable mediators that lies in the causal pathway between DGF duration and allograft loss is essential.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/tp.0000000000002275","type":"journal-article","created":{"date-parts":[[2018,5,15]],"date-time":"2018-05-15T21:58:29Z","timestamp":1526421509000},"page":"412-419","source":"Crossref","is-referenced-by-count":74,"title":["Association Between Duration of Delayed Graft Function, Acute Rejection, and Allograft Outcome After Deceased Donor Kidney Transplantation"],"prefix":"10.1097","volume":"103","author":[{"given":"Wai H.","family":"Lim","sequence":"first","affiliation":[]},{"given":"David W.","family":"Johnson","sequence":"additional","affiliation":[]},{"given":"Armando","family":"Teixeira-Pinto","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, University of Sydney, Sydney, Australia."}]},{"given":"Germaine","family":"Wong","sequence":"additional","affiliation":[]}],"member":"276","reference":[{"key":"bib1-20231002","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1038\/ki.2015.88","article-title":"Kidney donation after circulatory death (DCD): state of the art","volume":"88","year":"2015","journal-title":"Kidney Int"},{"key":"bib3-20231002","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1111\/j.1600-6143.2010.03179.x","article-title":"A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation","volume":"10","year":"2010","journal-title":"Am J Transplant"},{"key":"bib4-20231002","first-page":"1039","article-title":"Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis","volume":"24","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"bib5-20231002","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1097\/TP.0b013e3182855544","article-title":"Is delayed graft function causally associated with long-term outcomes after kidney transplantation? 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