Worsening Rather Than Severe Acute Kidney Injury Affects Kidney Transplantation Outcomes.
1Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
2Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
3Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Meeting: 2017 American Transplant Congress
Abstract number: C33
Keywords: Cadaveric organs, Graft function, High-risk, Kidney transplantation
Session Information
Session Name: Poster Session C: Deceased Donor Issues II: DCD, DGF, AKI, En-Bloc
Session Type: Poster Session
Date: Monday, May 1, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background
The growing evidence has suggested that deceased donor kidneys with acute kidney injury (AKI) may be a good solution to overcome organ shortage. Although previous studies have focused on fair outcome of donor AKI, there are only a few data concerning long-term transplantation outcomes in patients received deceased donor kidneys with AKI.
Methods
We included all patients who received decreased donor kidney transplant from 2005 to 2014. Clinical characteristics of both donors and recipients was investigated retrospectively. Deceased donor AKI was defined and staged by KDIGO criteria. Donor AKI was further classified into worsening AKI or not based on creatinine slopes over 48-hours before organ donation. Primary renal outcome was graft failure needing maintenance renal replacement therapy or estimated glomerular filtration rate (eGFR) less than 15 mL/min/1.73 m2. Secondary renal outcome was annual graft function.
Results
Among a total of 413 patients, 156 (38.5%) received kidneys from AKI donors including 84 stage 1, 38 stage 2, and 34 stage 3. AKI developed more in ECD and hypotensive donors. Among 156 AKI donors, 76 revealed worsening renal function immediate before kidney donation. AKI donors showed lower blood pressure and used more inotropic drugs during organ procurement period. Recipients who were received AKI donor's kidney were treated more induction immunosuppressive treatment. In the survival analysis, there was no significant difference in delayed graft function, overall graft and recipient survival according to AKI development and stage, although 5-year eGFR was significantly lower in stage 3 AKI (P = 0.019) than others. Interestingly however, worsening AKI elevated graft failure risk (adjusted HR 4.420, 95% CI 1.35-14.43, P = 0.014) even after multivariate adjustment including AKI stage and terminal creatinine.
Conclusions
In this study, we demonstrated that worsening AKI was an independent risk factor for graft failure in deceased donor kidney transplantation. On the contrary, donor AKI itself did not affect overall graft survival, although severe AKI reduced 5-year graft function.
CITATION INFORMATION: Yu M.-Y, Yu B, Kim Y, Mi S, Ha J, Yang J, Kim Y, Lee H. Worsening Rather Than Severe Acute Kidney Injury Affects Kidney Transplantation Outcomes. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Yu M-Y, Yu B, Kim Y, Mi S, Ha J, Yang J, Kim Y, Lee H. Worsening Rather Than Severe Acute Kidney Injury Affects Kidney Transplantation Outcomes. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/worsening-rather-than-severe-acute-kidney-injury-affects-kidney-transplantation-outcomes/. Accessed May 25, 2025.« Back to 2017 American Transplant Congress