Associations of Deceased Donor Kidney Injury With Kidney Discard and Function After Transplantation

Abstract

Deceased-donor kidneys with acute kidney injury (AKI) are often discarded due to fear of poor outcomes. We performed a multicenter study to determine associations of AKI (increasing admission-to-terminal serum creatinine by AKI Network stages) with kidney discard, delayed graft function (DGF) and 6-month estimated glomerular filtration rate (eGFR). In 1632 donors, kidney discard risk increased for AKI stages 1, 2 and 3 (compared to no AKI) with adjusted relative risks of 1.28 (1.08–1.52), 1.82 (1.45–2.30) and 2.74 (2.0–3.75), respectively. Adjusted relative risk for DGF also increased by donor AKI stage: 1.27 (1.09–1.49), 1.70 (1.37–2.12) and 2.25 (1.74–2.91), respectively. Six-month eGFR, however, was similar across AKI categories but was lower for recipients with DGF (48 [interquartile range: 31–61] vs. 58 [45–75] ml/min/1.73m2 for no DGF, P<0.001). There was significant favorable interaction between donor AKI and DGF such that 6-month eGFR was progressively better for DGF kidneys with increasing donor AKI (46 [29–60], 49 [32–64], 52 [36–59] and 58 [39–71] ml/min/1.73m2 for no AKI, stage 1, 2 and 3, respectively; interaction P=0.05). Donor AKI is associated with kidney discard and DGF, but given acceptable 6-month allograft function, clinicians should consider cautious expansion into this donor pool.

Associations between Deceased-Donor Urine Injury Biomarkers and Kidney Transplant Outcomes

“…However, consistent with work by our group and others, we find only minor adverse effects of donor AKI on posttransplant recipient outcomes. 33,34 This study provides additional evidence that transplantation using deceased-donor kidneys with AKI often leads to good allograft function and that transplant centers should consider acceptance of these kidneys. On the other hand, the development of better tools to profile donor kidney quality and extend the survival of transplanted kidneys remains a high priority for the field of transplantation.…”

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

“…Mean serum creatinine concentration was 2.41 ± 0.88 mg/dL at time of procurement and 1.06 ± 0.32 mg/dL on admission in AKI donors, and 0.81 ± 0.26 mg/dL in controls (Table 1). AKI donors had a lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009), were more frequently exposed [13][14][15][16][17][18][19][20][21][22][23] days in controls, p = 0.05) ( Table 3). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14 (Fig.…”

“…Outcome was not different in the three strata with regard to patient/graft survival, and renal function [12]. Unexpectedly, the well-known adverse effect of delayed graft function (DGF) on graft survival could not be seen in recipients of AKI kidneys, but was evident in recipients of standard donor kidneys [12,18]. Klein et al [13] reported their extensive center experience in a study of 1518 renal transplant recipients between 1998 and 2008, including 485 transplants from a DBD with AKI (defined by a donor serum creatinine concentration >1.5 mg/dL).…”

“…However, in the last 10 years, case reports and large case series have been published and clinical practice has been changing, i.e., AKI kidneys from wellselected DBDs can successfully be used for transplantation [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Specifically, two recent large studies deserve to be highlighted.…”

Performance of Serum Creatinine and Kidney Injury Biomarkers for Diagnosing Histologic Acute Tubular Injury

“…14,15 Briefly, we collaborated with five organ procurement organizations (OPOs). These OPOs collected donor urine samples as per study protocol at the time of organ procurement between April 2010 and November 2013 from donors whose surrogates had given consent for research.…”