Outcomes of kidney transplant from deceased donors with acute kidney injury and prolonged cold ischemia time - a retrospective cohort study

Abstract

Summary While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) or long cold ischemia time (CIT) are associated with increased risk of delayed graft function (DGF), recipients of these kidneys have good patient and allograft survival. There are limited data on whether kidneys with both AKI and long CIT have outcomes similar to kidneys with only one of these insults. Using data from the Scientific Registry of Transplant Recipients, we analyzed transplant outcomes in patients (2005–2015) receiving kidneys with AKI (terminal creatinine ≥2.0 mg/dl) and CIT 24–30 h (n = 1289), 30–36 h (n = 734), and >36 h (n = 614), using kidneys with AKI and CIT <24 h (n = 5434) as a reference. DGF was more common with increasing CIT up to 36 h, then decreased slightly (41.2% vs. 46.8% vs. 52.5% vs. 50.2%, P < 0.001). Death‐censored graft survival (DCGS) at 3 years was better with CIT <24 h compared with other groups (92.5% vs. 90.8% vs. 92% vs. 89.2%, P = 0.018). On multivariable analysis, donor creatinine was predictive of DCGS, whereas only CIT >36 h was predictive of DCGS (aHR 1.27, P = 0.03). Recipients transplanted with kidneys with both AKI and long CIT have excellent intermediate‐term outcomes.

Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts

“…The increasing demand for allografts and growing waiting lists have led to the utilisation of organs from extended criteria donors (ECDs) or organs with prolonged ischemic times [1]. These organs are associated with higher rates of discard due to an anticipated increased risk of primary non function (PNF) or delayed graft function (DGF); therefore, novel dynamic preservation technologies are increasingly being adopted with the aim to allow organ utilisation in these circumstances.…”

Kidney nonprocurement in solid organ donors in the United States

“…Due to the limitations in creatinine kinetics in our data set, acute kidney injury (AKI) was defined in our study as a terminal creatinine >2 mg/dL and is an independent risk factor for discard that is associated with a higher proportion of discards than kidneys from donors without AKI (30% vs 18%, respectively) 37‐39 . However, there is now considerable evidence that AKI is often reversible and that kidneys from donors with AKI provide short‐ and long‐term graft survival and function comparable to kidneys with nonelevated terminal creatinine 37,40‐46 . Liu et al’s 47 recent comparison of propensity score‐matched deceased donors with AKI to deceased donors without AKI demonstrated that deceased donor AKI had no independent association with short‐term and long‐term recipient graft survival across all AKI stages.…”

“…[37][38][39] However, there is now considerable evidence that AKI is often reversible and that kidneys from donors with AKI provide short-and long-term graft survival and function comparable to kidneys with nonelevated terminal creatinine. 37,[40][41][42][43][44][45][46] Liu et al's 47 This study has several limitations. We rely on OPTN registry data, which may contain reporting errors.…”

“…However, our analysis controls for risk factors of chronic disease and many previous studies analyzing AKI kidneys also define AKI based on terminal creatinine. 40,43,44,50 Finally, our focus is on highlighting that many potentially procurable kidneys with elevated terminal creatinine levels are being left behind in donors. Given changing OPTN policies and recommended clinical practices over time, more detailed time-based analyses are important and should be the subject of further investigation.…”

Impact of warm ischemia time on outcomes for kidneys donated after cardiac death Post‐KAS

“…However, although both prolonged WIT and CIT have been found to increase risk of DGF in these organs, for major endpoints such as graft and patient survival, DCD kidneys with high WIT and CIT have not been found to carry significantly higher hazards when compared with DBD kidneys 5‐9 . These analyses, though, were performed prior to the implementation of the new Kidney Allocation System (KAS) in December 2014, after which average CIT increased and organ utilization patterns changed 10 . Given the proposed new allocation strategies that are likely to result in increased organ sharing, we attempt to determine whether WIT and/or CIT was associated with post‐transplant outcomes for DCD allografts in the post‐KAS era.…”