Distribution of per- and polyfluoroalkyl substances in renal vascular tissues from donors after brain death and association with post-transplant delayed graft function risk.

Delayed graft function (DGF) is a major complication after kidney transplantation, yet the potential impact of per- and polyfluoroalkyl substances (PFAS) in donor kidney tissue remains unclear. For the first time, this study enrolled donors after brain death to investigate the association between PFAS burden in renal vascular tissues of donor kidneys and recipient DGF. We conducted a retrospective case-control study at Shandong Qianfoshan Hospital from January 2025 to January 2026. Following standardized inclusion and exclusion criteria, 43 DGF recipients and 43 non-DGF recipients were enrolled. Liquid chromatography-triple quadrupole mass spectrometry was used to quantify 32 PFAS compounds in donor renal vascular tissues. Analyses included group comparisons, Spearman correlation, and multivariable logistic regression with Benjamini-Hochberg FDR correction, adjusting for donor age, terminal serum creatinine, cold ischemia time, recipient sex, age, and body mass index. DGF group exhibited higher concentrations of multiple PFAS. Regression analysis revealed that in renal arterial tissue, PFOA (OR = 2.004, 95%CI:1.035-3.880), PFDA (OR = 1.762, 95%CI:1.012-3.066), PFOS (OR = 1.706, 95%CI:1.006-2.893), PFNA (OR = 1.673, 95%CI:1.010-2.774), PFUnDA (OR = 1.722, 95%CI:1.018-2.910), PFHxS (OR = 1.619, 95%CI:1.004-2.612), and 6:2 Cl-PFESA (OR = 1.812, 95%CI:1.010-3.251) were potentially associated with DGF after FDR correction (q < 0.1). In renal venous tissue, PFOA (OR = 1.707, 95%CI:1.014-2.874), PFDA (OR = 1.634, 95%CI:1.027-2.600), and PFUnDA (OR = 1.679, 95%CI:1.026-2.746) showed only nominal associations without statistical significance after FDR adjustment. Thus, arterial PFAS burden appears more relevant to DGF than venous PFAS. As an exploratory observational study, causality cannot be established, and interpretation of the findings should be cautious. Nevertheless, these results offer plausible hypotheses​ and provide directions for future research.