Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney Injury

Abstract

Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ≤1.5, 1.6-2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6-2.0 and >2.0 mg/dL, compared to ≤1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5-7.6) and 1.6-2.0 mg/dL (AOR 2.7; CI 2.5-2.9) relative to sCr ≤1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury.

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

“…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.…”

Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes

“…Several factors directly or indirectly related to AKI have been evaluated in transplantation, including preservation technique, cold-ischemia time, and donor terminal creatinine (10), although many authors argue against discarding kidneys based on high creatinine levels alone (2,(11)(12)(13). Little attention, however, has been given to assessing the degree of structural AKI in the donor apart from conventional "proxy" measures such as cold-ischemia time or creatinine.…”

Whether or not to accept a deceased donor kidney offer for a pediatric patient

“…The peak creatinine may be less relevant if it is falling or has fallen to normal at the time of procurement of organs [1]. Ideal donors generally have serum creatinine levels close to normal, although a higher creatinine level is not necessarily associated with a poorer outcome [2]. Elevated creatinine levels can be a predictor of poor graft function, and require further evaluation to determine renal function.…”