Evolving Experience Using Kidneys from Deceased Donors with Terminal Acute Kidney Injury

Farney, Alan C.; Rogers, Jeffrey; Orlando, Giuseppe; Al-Geizawi, S.; Buckley, Michael R.; Farooq, Umar; Al-Shraideh, Yousef; Stratta, Robert J.

doi:10.1016/j.jamcollsurg.2012.12.020

Cited by 81 publications

(159 citation statements)

References 48 publications

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“…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.…”

Section: Discussionmentioning

confidence: 79%

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

Reese

Hall

Weng

et al. 2015

JASN

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Assessment of deceased-donor organ quality is integral to transplant allocation practices, but tools to more precisely measure donor kidney injury and better predict outcomes are needed. In this study, we assessed associations between injury biomarkers in deceased-donor urine and the following outcomes: donor AKI (stage 2 or greater), recipient delayed graft function (defined as dialysis in first week post-transplant), and recipient 6-month eGFR. We measured urinary concentrations of microalbumin, neutrophil gelatinaseassociated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), IL-18, and liver-type fatty acid binding protein (L-FABP) from 1304 deceased donors at organ procurement, among whom 112 (9%) had AKI. Each biomarker strongly associated with AKI in adjusted analyses. Among 2441 kidney transplant recipients, 31% experienced delayed graft function, and mean6SD 6-month eGFR was 55.7623.5 ml/min per 1.73 m 2 . In analyses adjusted for donor and recipient characteristics, higher donor urinary NGAL concentrations associated with recipient delayed graft function (highest versus lowest NGAL tertile relative risk, 1.21; 95% confidence interval, 1.02 to 1.43). Linear regression analyses of 6-month recipient renal function demonstrated that higher urinary NGAL and L-FABP concentrations associated with slightly lower 6-month eGFR only among recipients without delayed graft function. In summary, donor urine injury biomarkers strongly associate with donor AKI but provide limited value in predicting delayed graft function or early allograft function after transplant.

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Section: Discussionmentioning

confidence: 79%

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

Reese

Hall

Weng

et al. 2015

JASN

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“…Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 glomerular filtration rate (eGFR): 10-20, 20-30, and >30 mL/ min. 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].…”

Section: Introductionmentioning

confidence: 84%

“…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.…”

Section: Introductionmentioning

confidence: 99%

“…Farney et al [12] have compared the outcomes of 84 renal transplant recipients receiving a renal allograft from a DBD with preexisting AKI (mean serum creatinine concentration on admission of 1.25 mg/dL and at the last measurement before donation of 3.22 mg/dL) with 283 transplants from a standard DBD with normal renal function (mean serum creatinine concentration 1.03 mg/dL before donation). Otherwise, donors were very similar, i.e., mean donor age of 36 versus 35 years [12]. Remarkably, 5-year patient and graft survival was comparable between both groups.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…It is also clear that microthrombi on a pre-implantation biopsy may be a reason to refuse a kidney offer [4]. We present here a case where a deceased donor received heparin despite HIT, and the kidney was transplanted with good results despite microthrombi on biopsy.…”

Section: Introductionmentioning

confidence: 91%

Successful Kidney Transplant Despite Microthrombi From a Deceased Donor With Heparin Induced Thrombocytopenia

Osband

2014

J Curr Surg

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Many deceased donor factors determine utility of procured organs. In addition to the large dose of intravenous heparin usually given prior to aortic cross-clamp, kidneys are flushed with heparinized solution pre-implantation. In a donor with heparin induced thrombocytopenia (HIT), these exposures may lead to microthrombi, which may be a reason to refuse a kidney offer. We present a case of successful renal transplantation of a highly sensitized patient from a donor with HIT and microthrombi on biopsy.

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Evolving Experience Using Kidneys from Deceased Donors with Terminal Acute Kidney Injury

Cited by 81 publications

References 48 publications

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

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

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

Successful Kidney Transplant Despite Microthrombi From a Deceased Donor With Heparin Induced Thrombocytopenia

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