Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury

Abstract

Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin‐fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non‐AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p‐value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes.

Rapid Resolution of Donor-Derived Glomerular Fibrin Thrombi After Deceased Donor Kidney Transplantation

“…Twenty-two of 61 in the GFT group had both preimplantation and postreperfusion biopsies performed: 18 showed GFT on both biopsies, 3 had GFT on postreperfusion biopsy only and 1 had GFT on the preimplantation biopsy only. The median for the number of glomeruli in the reperfusion biopsies was 15 (25-75% range: [11][12][13][14][15][16][17][18][19][20] in the GFT group and 14 (25-75% range: 10-21) in the control group (p ¼ 0.87).…”

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

“…Mean serum creatinine concentration was 2.41 ± 0.88 mg/dL at time of procurement and 1.06 ± 0.32 mg/dL on admission in AKI donors, and 0.81 ± 0.26 mg/dL in controls (Table 1). AKI donors had a lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009), were more frequently exposed [13][14][15][16][17][18][19][20][21][22][23] days in controls, p = 0.05) ( Table 3). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14 (Fig.…”

“…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.…”

Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries

“…Increased incidence of delayed graft function (DGF)[3,4] is a significant disadvantage of using kidneys from AKI donors. This can lead to increased hospital stay and cost of treatment or even worse allograft function[5] when compare with KT from SCD.…”

“…This can lead to increased hospital stay and cost of treatment or even worse allograft function[5] when compare with KT from SCD. In addition, it is uncertain whether KT from AKI donor is associated with increased risk of acute rejection or allograft loss when compare with KT from using kidney from standard deceased donor[3,4]. Since AKI can occur from different causes and have different severities, the outcomes of KT from donors with AKI may be varied.…”