Good Outcomes in Kidney Transplantation With Deceased Donor With Acute Kidney Injury: Donor's Age and Not Acute Kidney Injury Predicts Graft Function

Nga, Hong Si; Takase, Henrique Mochida; Bravin, Ariane Moyses; Garcia, Patrícia Carvalho; Contti, Mariana Moraes; Kojima, Christiane Akemi; Andrade, Luís Gustavo Modelli de

doi:10.1016/j.transproceed.2016.06.004

Cited by 13 publications

(4 citation statements)

References 18 publications

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“…Several studies have observed that organs from donors with AKI are associated with a higher incidence of DGF, but all these studies focused on adult donors. Si Nga et al explored the relationship between DGF and donor age (mean age >50 years) among adult donors with AKI and found that one additional year of donor age increased the risk of DGF by 1.08 times ( P = 0.01); however, AKI stages could not predict the risk of DGF . By contrast, we noted an increased incidence of DGF in higher AKI stages, and the multivariate regression analysis of adult groups confirmed that the higher was the AKI stage, the higher was the risk of DGF.…”

Section: Discussionsupporting

confidence: 57%

Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Jiang

Song

Liu

et al. 2019

Pediatric Transplantation

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Introduction Despite a severe shortage of organ supply, patients are reluctant to accept organs from deceased donors with AKI, let alone from pediatric AKI donors. Methods We assessed 70 patients who received kidneys from donors with AKI (10 with pediatric and 60 with adult donors) and 176 contemporaneous patients who received kidneys from non‐AKI donors (41 with pediatric and 135 with adult donors) between March 2012 and February 2017 for retrospectively evaluating the clinical outcomes. Results AKI was defined and staging by the RIFLE criteria and pediatric‐modified RIFLE criteria. Median age was 11.00 years IQR (4.50‐14.00 years), and median weight was 25.00 kg (IQR, 17.00‐45.00 kg) for all pediatric donors. Median follow‐up was 8 months (range, 1‐49 months). Adult AKI group had the highest incidence of DGF (35.0% vs 10%, 9.8%, and 19.3%, P = 0.011). There was a significant increase in DGF in higher AKI stages (Risk: 20.7%, Injury: 46.7%, Failure: 50.0%; P = 0.014) among patients with adult donors. No significant differences were noted in 1‐year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) and 3‐year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) patient survival, and 1‐year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) and 3‐year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) graft survival. Conclusion Transplants procured from donors with AKI, particularly pediatric ones, could achieve excellent intermediate‐term clinical outcomes and thus potentially expand the donor pool.

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Section: Discussionsupporting

confidence: 57%

Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Jiang

Song

Liu

et al. 2019

Pediatric Transplantation

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“…5,8 This characteristic is also important to consider in cases of renal donation whose donor is in AKI, the age of the donor, rather than the final creatinine value has a greater association with outcome and worsening renal function in 6 months. 9 The histological assessment of the AKI kidneys is fundamental, as it shows their viability before implantation. The absence or discrete histological lesions correlate with good graft survival in one year, favoring the use of the organ offered; while the presence of moderate to severe lesions correlates with poor graft survival, making transplantation unwise.…”

Section: Discussionmentioning

confidence: 99%

“…All patients reported in this series had DGF, as expected, since the percentage of graft delay in renal donors with AKI is high. 6,7,8,9 The main risk factor and probable etiological factor for DGF is the KDIGO III AKI diagnosis validity prior to donation. Other risk factors include the long dialysis time prior to transplantation in the first case and the 25-hour CID in the third case.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

et al. 2019

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Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.

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“…There is no evidence that AKI in donor kidneys has an impact on acute rejection episodes in recipients [17]. Many studies have presented similar survival rates for kidneys from AKI and non-AKI groups, despite using different definitions of AKI [18]. Zuckerman et al.…”

Section: Discussionmentioning

confidence: 99%

Successful transplantation of kidneys from deceased donors with terminal acute kidney injury

et al. 2019

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Background: There are many doubts with regards to accepting deceased kidneys with acute kidney injury (AKI) for transplantation. Purpose: The aim of this study was to present the 5-years outcome of kidney transplantation cases where deceased donors developed AKI before organ procurement. Methods: Two hundred twenty-six deceased renal transplants were analyzed. Data regarding donors and recipients were collected. Terminal AKI was defined as terminal serum creatinine concentration higher than 1.99 mg/dL and 66 such cases were diagnosed. All kidney transplant recipients were followed for 60 months. Results: AKI group presented more episodes of delayed graft function (DGF) compared to the non-AKI group (56% vs 35%, p < .05). No differences were observed between the groups in the rate of acute rejection episodes, kidney function as well as patient and graft survival. Conclusions: Transplants with AKI present more often DGF and comparable graft survival to transplants without AKI. Kidneys with AKI can be a valuable source of organs provided attentive selection and appropriate care of deceased donors.

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Good Outcomes in Kidney Transplantation With Deceased Donor With Acute Kidney Injury: Donor's Age and Not Acute Kidney Injury Predicts Graft Function

Abstract: Kidney transplantation of organs from deceased donors with AKI showed greater DGF but good outcomes. Donor age was the only characteristic that correlated with outcome.

Cited by 13 publications

References 18 publications

Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

Successful transplantation of kidneys from deceased donors with terminal acute kidney injury

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