Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury

Abstract

Background. Kidneys from deceased donors with acute kidney injury (AKI) are more likely to be discarded because of concerns for poor outcomes after transplantation. The aim of this study was to determine the long-term outcomes of a large cohort of patients transplanted utilizing kidneys from deceased donors with AKI. Methods. All patients receiving a deceased donor kidney transplant during a recent 10-year period were included. Acute Kidney Injury Network (AKIN) criteria were used to classify the donors. Donor kidneys with >10% cortical necrosis or more than mild chronic changes were discarded. The primary outcome is the combined endpoint of death or graft loss. Results. The cohort included 1313 kidneys from 974 donors, AKIN stage 0 (no AKI) in 319 (24.3%), stage 1 in 370 (28.2%), stage 2 in 177 (13.5), and stage 3 in 447 (34.0%). Estimated 5-year graft survival (95% confidence interval) was 78.5% (72.5-84.5), 77.8% (72.8-82.1), 83.8% (76.8-88.9), and 84.6% (79.5-88.7) for AKIN donor stage 0 to 3, respectively (log-rank P = 0.10). After adjusting for baseline differences, the hazard ratio (95% confidence interval) for the combined endpoint for the AKIN stage 3 group (relative to AKIN 0 group) was 0.70 (0.45-1.10). Delayed graft function occurred in 44.6% and 75.4% of AKIN 2 and 3 groups, as compared to 33.9% and 33.5% in AKIN 0 and 1 (P < 0.001). Conclusion. We conclude that transplanting selected kidneys from deceased donors with AKI with preimplantation biopsy showing <10% cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.

Simultaneous liver–kidney transplantation from donation after cardiac death donors: an updated perspective

“…These outcomes are consistent with our centers' experience with solitary DCD liver and kidney allografts as well as with the most recent national UNOS data. 11,14 In this updated series on DCD SLK, we found the incidence of ischemic cholangiopathy to be low at 10.0% and no DCD liver allografts were lost to ischemic cholangiopathy within the first year (Tables 4 and 5 11,19,20 In this series, the observed DGF rates were higher in the DCD cohort (40.0% vs 23.7%) although this did not reach statistical significance ( Table 2). The length of DGF was also found to be longer in the DCD SLK cohort (median 20 vs 4 days).…”

“…21 More recently, we have looked at the impact of DGF in the setting of severe acute kidney injury donors, DCD donors, and extended-criterion donors (kidney donor profile index [KDPI] ≥ 85%). 11,19,20 For these donors, the observed duration of DGF is also longer (median 10 days versus 8 days) but does not impact long-term renal function recovery. 19,20 TA B L E 3 SLK biopsy results In addition, despite longer periods of DGF, we have not observed any differences on protocol biopsy specific to IFTA or fibrosis progression.…”

“…11,19,20 For these donors, the observed duration of DGF is also longer (median 10 days versus 8 days) but does not impact long-term renal function recovery. 19,20 TA B L E 3 SLK biopsy results In addition, despite longer periods of DGF, we have not observed any differences on protocol biopsy specific to IFTA or fibrosis progression. These findings are consistent with our experience using solitary DCD kidney allografts.…”

Safety and Effectiveness of Kidney Transplantation Using a Donation-After-Brain-Death Donor With Acute Kidney Injury: A Retrospective Cohort Study

“…Previous studies showed that donors with AKI were associated with a higher rate of DGF 7,8,10,15 , and that the DGF rate was higher with AKIN stage 2 and 3 disease 9,16 . Similarly in our study, the DGF rate tended to increase with the donor AKI stage, especially in stage 3.…”

“…Domagala et al 10 reported nding no difference in the rate of biopsy-proven acute rejection (BPAR) episodes between donors with and without AKI in the rst year post-transplantation. Those reports thus found no relationship between donors with AKI and graft survival [7][8][9][10] . Nonetheless, debate continues regarding the use of donors with AKI.…”