Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival

Liu, Caroline; Hall, Isaac E.; Mansour, Sherry G.; Thiessen-Philbrook, Heather; Jia, Yaqi; Parikh, Chirag R.

doi:10.1001/jamanetworkopen.2019.18634

Cited by 55 publications

(101 citation statements)

References 52 publications

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“…However, there is now considerable evidence that AKI is often reversible and that kidneys from donors with AKI provide short‐ and long‐term graft survival and function comparable to kidneys with nonelevated terminal creatinine 37,40‐46 . Liu et al’s 47 recent comparison of propensity score‐matched deceased donors with AKI to deceased donors without AKI demonstrated that deceased donor AKI had no independent association with short‐term and long‐term recipient graft survival across all AKI stages. Although elevated creatinine in the setting of chronic kidney disease (CKD) in the donor would be a justifiable reason for nonprocurement, severe kidney disease may also preclude procurement of nonrenal organs such as heart and lungs.…”

Section: Discussionmentioning

confidence: 99%

“…[37][38][39] However, there is now considerable evidence that AKI is often reversible and that kidneys from donors with AKI provide short-and long-term graft survival and function comparable to kidneys with nonelevated terminal creatinine. 37,[40][41][42][43][44][45][46] Liu et al's 47 This study has several limitations. We rely on OPTN registry data, which may contain reporting errors.…”

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confidence: 88%

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Kidney nonprocurement in solid organ donors in the United States

King

Husain

et al. 2020

American Journal of Transplantation

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There are limited data on the nonprocurement of kidneys from solid organ donors. Analysis of Standard Transplant Analysis and Research files was undertaken on all deceased donors in the United States with at least 1 solid organ recovered. From 2000 to 2018, 21 731 deceased donor kidneys (averaging 1144 kidneys per year) were not procured. No kidneys were procured from 8% of liver donors, 3% of heart donors, and 3% of lung donors. Compared to donors with all kidneys procured, those with none procured were older and more likely obese, black, hypertensive, diabetic, hepatitis C positive, smokers, Public Health Service – Increased Risk designated, deceased after cardiac death, or deceased after cerebrovascular accident. Although these donors had lower quality kidneys (median Kidney Donor Risk Index (interquartile range) 1.9 (1.0) vs 1.2 (0.7)), there was substantial overlap in quality between nonprocured and procured kidneys. Nearly one third of nonprocurements were attributed to donor history. Donors with elevated terminal creatinine likely resulting from acute kidney injury (AKI) had higher odds of kidney nonprocurement. Nonprocurement odds varied widely across Organ Procurement and Transplantation Network regions, with a positive correlation between donor kidney nonprocurements and kidney discards at the donation service area level. These findings suggest current discard rates underestimate the underutilization of deceased donor kidneys and more research is needed to optimize safe procurement and utilization of kidneys from donors with AKI.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 88%

Kidney nonprocurement in solid organ donors in the United States

King

Husain

et al. 2020

American Journal of Transplantation

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“…Donors’ serum creatinine also had to be within normal range at the time of the organ procurement, so kidneys from donors with acute kidney injury (AKI) were discarded even if they had no substantial comorbidities, and so were kidneys from donors with a history of hypertension but no evidence of any organ damage. There is growing evidence of donated kidneys with AKI achieving much the same long‐term renal function and graft survival rates as those without AKI [15]. Donors with mild hypertension well controlled with antihypertensive medication, and no evidence of organ damage is now considered suitable, not expanded criteria donors [16].…”

Section: Focus On Deceased Donor‐initiated Chainsmentioning

confidence: 99%

Kidney exchange strategies: new aspects and applications with a focus on deceased donor‐initiated chains

et al. 2020

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Kidney paired donation (KPD) is a valuable way to overcome immunological incompatibility in the context of living donation, and several strategies have been implemented to boost its development. In this article, we reviewed the current state of the art in this field, with a particular focus on advanced KPD strategies, including the most recent idea of initiating living donor (LD) transplantation chains with a deceased donor (DD) kidney, first applied successfully in 2018. Since then, Italy has been running a national programme in which a chain-initiating kidney is selected from a DD pool and allocated to a recipient with an incompatible LD, and the LD's kidney is transplanted into a patient on the waiting list (WL). At this stage, since the ethical and logistic issues have been managed appropriately, KPD starting with a DD has proved to be a feasible strategy. It enables transplants in recipients of incompatible pairs without the need for desensitizing and also benefits patients on the WL who are allocated chain-ending kidneys from LDs (prioritizing sensitized patients and those on the WL for longer).

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“…Several researches have recently been published regarding the clinical impact of KT from deceased donors (DDs) with acute kidney injury (AKI) in deceased donor KT (DDKT) [ 12 , 13 ]. AKI is very commonly detected in individuals with brain death state for various causes [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study

Park

Chang

Kim

et al. 2021

Kidney Res Clin Pract

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Background: This study evaluated the impact of acute kidney injury (AKI) on posttransplant clinical outcomes for deceased donor (DD) kidney transplantation (KT) using the Kidney Donor Profile Index (KDPI) system. Methods: Overall, 657 kidney transplant recipients (KTRs) receiving kidneys from 526 DDs from four transplant centers were included. We divided them into the high and low KDPI donor groups by 65%, the KDPI score, and both groups were subdivided into the AKI-DDKT and non-AKI-DDKT subgroups according to AKI in DDs. Results: There was no significant difference in the incidence of delayed graft function (DGF) between the high and low KDPI-KTR groups; however, the AKI-DDKT subgroup showed significantly higher incidence of DGF than the non-AKI-DDKT subgroup in both groups (p = 0.001, p < 0.001, respectively). The death-censored graft survival rate was significantly lower in the high KDPI-KTR group than in the low KDPI-KTR group (p = 0.005). Only in the high KDPI-KTR group, the death-censored graft survival rate was significantly lower in the KT from DDs with AKI stage 3 than KT from DDs with non-AKI or AKI stage 1 or 2 (p = 0.040). The interaction between AKI stage 3 in DDs and high KDPI on the allograft outcome was significant (p = 0.002). Conclusion: KTs from DDs with AKI stage 3 showed an adverse impact on the allograft outcome in the high KDPI-KTR group. Therefore, DDs with a high KDPI score should be managed carefully so that severe AKI does not occur prior to KT.

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Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival

Cited by 55 publications

References 52 publications

Kidney nonprocurement in solid organ donors in the United States

Kidney nonprocurement in solid organ donors in the United States

Kidney exchange strategies: new aspects and applications with a focus on deceased donor‐initiated chains

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study

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