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

Abstract

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.

Risk factors and outcomes of prolonged recovery from delayed graft function after deceased kidney transplantation

“…This finding reflects the association between the severity of acute kidney injury in the donor and DGF recovery time. Retrospective studies identified an association between increased donor final serum creatinine level and an increased risk of DGF [29,30], but failed to identify an association with prolonged DGF duration among recipients with DGF [17]. Dominguez et al [24] also investigated risk factors of prolonged DGF duration, and did not find an association with donor kidney function.…”

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

“…DGF is a risk factor for the development of early acute rejection 17,22 . However, previous studies reported that the acute rejection rate was not signi cantly higher among patients whose donors had AKI than among other KT recipients 7,8,10,15 . We also observed that donor AKI did not affect the acute rejection rate or rejection-free survival.…”

“…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.…”

“…In addition, the rate of DGF tended to increase with the AKI stage 8,9 . 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] .…”

Viability assessment and utilization of declined donor kidneys with rhabdomyolysis using ex vivo normothermic perfusion without preimplantation biopsy

“…Despite the aforementioned uncertainty, terminal donor creatinine has long been thought of as a negative indicator of posttransplant function. Studies have shown higher rates of delayed graft function and prolonged index hospital admission 6‐9 . These studies have, however, used varying absolute serum creatinine levels to stratify between the presence and severity of AKI.…”