Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study

Kim, Kyeong Deok; Lee, Kyo Won; Kim, Sang Jin; Lee, Ok Joo; Lim, Manuel; Jeong, Eun Sung; Kwon, Jieun; Yang, Jaehun; Oh, Jongwook; Park, Jae Berm

doi:10.1038/s41598-021-84977-1

Cited by 11 publications

(12 citation statements)

References 31 publications

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“…In the adult cohort, the incidence of DGF was higher in recipients of allografts with AKI than in those without AKI (38.5% vs. 17.4%, p<0.01) and tended to increase with the AKI stage, which is consistent with previous studies [6,32] . Lui et al [3] and Kwon et al [33] reported that deceased donor AKI status did not affect death-censored graft survival and patient survival in an adult study cohort with a similar survival rates, and it can provide favorable graft functions for the later enginery, which is consistent with our study, but they did not analyze the trend of SCr postoperatively.…”

Section: Discussionsupporting

confidence: 91%

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Liu

Zhang

Zhong

et al. 2022

Preprint

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Background: The use of kidneys from deceased donors with acute kidney injury (AKI) to expand the donor pool is an ongoing trend. Prior research on the utilization of AKI donor kidneys, especially from pediatric AKI donors, was limited and has been subject to small sample sizes. In this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI. Methods: This retrospective study compared the clinical results (including delayed graft function [DGF], acute rejection, patient and death-censored graft survival rates and renal function post-transplant) of kidney transplantation from deceased donors who were categorized as pediatric donors and adult donors with or without AKI, as defined by the Kidney Disease: Improving Global Outcomes (KIDGO) criteria, at our center between January 2018 and December 2020. Results: Of the 740 patients, 154 received kidneys from pediatric donors (with AKI group [n=41]; without AKI group [n=113]), and 586 received kidneys from adult donors (with AKI group [n=218]; without AKI group [n=368]). The baseline characteristics were similar in both cohorts. No significant difference was observed in 1-year patient survival, death-censored graft survival, or acute rejection between the AKI and non-AKI groups in both the pediatric and adult cohorts. However, compared with those transplanted with adult AKI kidneys, those transplanted with pediatric AKI kidneys showed a superior recovery of allograft function. In pediatric cohorts, no significant difference was found in serum creatinine/estimated glomerular filtration rate (SCr/eGFR) between the AKI and non-AKI groups, even in the first week post-transplant. In contrast, the post-transplant SCr/eGFR level of the AKI group recipients in adult cohorts did not recover to a level statistically similar to that of non-AKI recipients, even at 6-months post-transplant. Nonetheless, AKI kidney recipients were at an increased risk of DGF in both pediatric (34.1% vs. 16.8%) and adult (38.5% vs. 17.4%) cohorts. Conclusions: Kidney transplantation from deceased donors with AKI has short-term clinical outcomes comparable to those of non-AKI kidney transplantation. Pediatric AKI kidneys have a superior recovery of allograft function. The transplant community should utilize this donor pool to minimize waiting-list-related mortalities.

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Section: Discussionsupporting

confidence: 91%

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Liu

Zhang

Zhong

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In the adult cohort, the incidence of DGF was higher in recipients of allografts with AKI than in those without AKI (38.5% vs. 17.4%, p < 0.01) and tended to increase with the AKI stage, which is consistent with previous studies [ 6 , 32 ]. Lui et al [ 3 ] and Kwon et al [ 33 ] reported that deceased donor AKI status did not affect death-censored graft survival and patient survival in an adult study cohort with a similar survival rates, and it can provide favorable graft functions for the later enginery, which is consistent with our study, but they did not analyze the trend of SCr postoperatively.…”

Section: Discussionsupporting

confidence: 91%

Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury

et al. 2023

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Background The use of kidneys from deceased donors with acute kidney injury (AKI) to expand the donor pool is an ongoing trend. Prior research on the utilization of AKI donor kidneys, especially from pediatric AKI donors, was limited and has been subject to small sample sizes. In this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI. Methods This retrospective study compared the clinical results (including delayed graft function [DGF], acute rejection, patient and death-censored graft survival rates and renal function post-transplant) of kidney transplantation from deceased donors who were categorized as pediatric donors and adult donors with or without AKI, as defined by the Kidney Disease: Improving Global Outcomes (KIDGO) criteria, at our center between January 2018 and December 2020. Results Of the 740 patients, 154 received kidneys from pediatric donors (with AKI group [n = 41]; without AKI group [n = 113]), and 586 received kidneys from adult donors (with AKI group [n = 218]; without AKI group [n = 368]). The baseline characteristics were similar in both cohorts. No significant difference was observed in 1-year patient survival, death-censored graft survival, or acute rejection between the AKI and non-AKI groups in both the pediatric and adult cohorts. However, compared with those transplanted with adult AKI kidneys, those transplanted with pediatric AKI kidneys showed a superior recovery of allograft function. In pediatric cohorts, no significant difference was found in serum creatinine/estimated glomerular filtration rate (SCr/eGFR) between the AKI and non-AKI groups, even in the first week post-transplant. In contrast, the post-transplant SCr/eGFR level of the AKI group recipients in adult cohorts did not recover to a level statistically similar to that of non-AKI recipients, even at 6-months post-transplant. Nonetheless, AKI kidney recipients were at an increased risk of DGF in both pediatric (34.1% vs. 16.8%) and adult (38.5% vs. 17.4%) cohorts. Conclusions Kidney transplantation from deceased donors with AKI has short-term clinical outcomes comparable to those of non-AKI kidney transplantation. Pediatric AKI kidneys have a superior recovery of allograft function. The transplant community should utilize this donor pool to minimize waiting-list-related mortalities.

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“… 16 Importantly, kidneys with even severe AKI have been associated with a higher risk of delayed graft function, but overall favorable long-term outcomes. 16 - 19 However, AKI superimposed on an expanded criteria or marginal donor kidney has been associated with reduced long-term allograft survival. 20 Therefore, this may support the noted concerns regarding AKI in the older 60-year-old donor scenario (Section 2) where AKI was the second and third leading cause for decline in NDD and DCD donors, respectively.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Deceased Donor Kidney Offer Acceptance: A Survey of Canadian Transplant Nephrologists, General Surgeons and Urologists

Vinson

Cardinal

Parsons

et al. 2023

Can J Kidney Health Dis

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Background: Significant variability in organ acceptance thresholds have been demonstrated across the United States, but data regarding the rate and rationale for kidney donor organ decline in Canada are lacking. Objective: To examine decision making regarding deceased kidney donor acceptance and non-acceptance in a population of Canadian transplant professionals. Design: A survey study of theoretical deceased donor kidney cases of increasing complexity. Setting: Canadian transplant nephrologists, urologists, and surgeons making donor call decisions responding to an electronic survey between July 22 and October 4, 2022. Participants: Invitations to participate were distributed to 179 Canadian transplant nephrologists, surgeons, and urologists through e-mail. Participants were identified by contacting each transplant program and requesting a list of physicians who take donor call. Measurements: Survey respondents were asked whether they would accept or decline a given donor, assuming there was a suitable recipient. They were also asked to cite reasons for donor non-acceptance. Methods: Donor scenario-specific acceptance rates (total acceptance divided by total number of respondents for a given scenario and overall) and reasons for decline were determined and presented as a percentage of the total cases declined. Results: In all, 72 respondents from 7 provinces completed at least one question of the survey, with considerable variability between acceptance rates for centers; the most conservative center declined 60.9% of donor cases, whereas the most aggressive center declined only 28.1%, P-value < .001. There was an increased risk of non-acceptance with advancing age, donation after cardiac death, acute kidney injury, chronic kidney disease, and comorbidities. Limitations: As with any survey, there is the potential for participation bias. In addition, this study examines donor characteristics in isolation, however, asks respondent to assume there is a suitable candidate available. In reality, whenever donor quality is considered, it should be considered in the context of the intended recipient. Conclusion: In a survey of increasingly medically complex deceased kidney donor cases, there was significant variability in donor decline among Canadian transplant specialists. Given relatively high rates of donor decline and apparent heterogeneity in acceptance decisions, Canadian transplant specialists may benefit from additional education regarding the benefits achieved from even medically complex kidney donors for appropriate candidates relative to remaining on dialysis on the transplant waitlist.

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Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study

Cited by 11 publications

References 31 publications

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury

Disparities in Deceased Donor Kidney Offer Acceptance: A Survey of Canadian Transplant Nephrologists, General Surgeons and Urologists

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