BackgroundThe acceptance of organs from deceased donors with acute kidney injury (AKI) varies considerably, with uncertain outcomes. The current organ shortage has led to increased use of marginal donor organs.Material/MethodsThis retrospective, single-center study included 642 patients who underwent kidney allograft transplantation between 2005 and 2016. The recipients were categorized into 3 groups: AKI-1 (n=214), comprising donors with a peak serum creatinine (SCr) level of 1.1–2.0 mg/dl; AKI-2 (n=89), comprising donors with a peak SCr level >2 mg/dl; and non-AKI (n=339), comprising donors with normal kidney function (SCr <1.1 mg/dl).ResultsThe cumulative survival rates for patients and grafts did not significantly differ among the AKI-1, AKI-2, and non-AKI groups at the 1-year (91.6%/79.4%, 92.1%/83.1%, 95.3%/88.5%, respectively) and 5-year assessments (79.4%/67.8%, 86.8%/71.7%, 80.5%/71.1%, respectively). These findings were corroborated by mean SCr values and estimated glomerular filtration rates at the 1-year (2.08±1.7/51.16±23.45, 2.01±1.52/56.46±23.63, 1.81±1.13/ 55.44±23.26 mg/dl, respectively) and 5-year assessments (1.91±1.28/51.06±24.65, 1.74±0.66/57.44±31.21, 1.7±0.88/ 58.56±26.04 mg/dl, respectively). The incidence of delayed graft function in each group was 29.9%, 44.9%, and 28.6%, respectively.ConclusionsKidney transplantation from donors with AKI, although associated with a higher rate of delayed graft function, results in good long-term transplant survival and reliable kidney functionality after 5 years. The inclusion of donors with AKI may widely extend the pool of available organs; however, careful donor selection is necessary.

BackgroundThe pre-procurement pancreas allocation suitability score (P-PASS) was introduced to support clinical decision-making and ultimately expand the currently insufficient pancreas donor pool. The pancreas donor risk index (PDRI) can be used at the time of organ offering to predict one-year graft survival. Thus, this study aimed to analyze the validity of the PDRI and P-PASS in a large German transplant center.Material/MethodsFrom 2002 to 2015, we performed 327 pancreas transplantations at our center. P-PASS and PDRI were calculated for 322 patients. To evaluate the pancreas graft survival, the patient cohort was divided into 2 P-PASS (<17, n=115 and ≥17, n=207) and 3 PDRI groups (<1, n=87; 1–1.5, n=133; and >1.5, n=102). Kaplan-Meier and Cox regression analyses were performed. We also examined differences regarding early pancreas graft failure for both scores using the chi-square test.ResultsThe PDRI was associated with pancreas graft survival in the univariate analysis (p=0.023). In the multivariate analysis, a PDRI >1.5 was associated with significantly decreased graft survival (hazard ratio=1.792, 95% confidence interval=1.10–2.90, p=0.018). The P-PASS showed no significant association (p=0.081) with pancreas graft survival in the Kaplan-Meier survival analysis. There were significantly more early pancreas graft losses in the P-PASS ≥17 group (p=0.025).ConclusionsOur results showed an association between P-PASS ≥17 and early pancreas graft failure. However, this does not apply to long-term pancreas graft survival; the PDRI proved to be a better tool for this, and PDRI values >1.5 were associated with significantly worse outcomes after pancreas transplantation.

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