Background

Deceased donor kidneys with acute kidney injury (AKI) are a viable source of organs, yet are frequently discarded. Outcomes of deceased donor renal transplantation (DDRT) from deceased after cardiac death (DCD) donors with AKI are not known.

Methods

A retrospective review of outcomes from DDRTs performed from 2006-2016 was conducted using SRTR data. Donors were stratified as DCD or brain dead (BD) and by terminal Creatnine (Cr). Recipients were followed until graft failure, death, or the end of study. Cox regression was used to adjust for covariates affecting the incidence of delayed graft function (DGF) and graft survival. Kaplan-Meier curves were generated to compare survival and function for DDRT recipients of DCD and BD grafts with stage 1 (Cr1.5 – 2), stage 2 (Cr ≥2 – 4) and stage 3 (Cr ≥ 4) AKI, according to AKI network criteria.

Results

91,462 patients were included. Demographic information is shown below.

The adjusted odds of DGF in DCD recipients were higher for all AKI stages. There was a higher risk of graft failure or death in DCD graft recipients from donors with stage 2 AKI (HR 1.38, p<0.001). This was not noted in other DCD recipients.

Conclusions

Stage 1 AKI DCD grafts have equivalent outcomes to those from AKI-matched BD donors. Stage 2 AKI DCD donors have worse outcomes. Though stage 3 DCD outcomes may be equivalent, significantly fewer of these grafts were studied. All transplanted kidneys likely outperform waitlist/dialysis survival. Further study is needed to characterize specific variables influencing success of DDRT from DCD donors with AKI.

CITATION INFORMATION: Grodstein E., Yang J., Nair V., Teperman L. Outcomes of DCD Renal Transplantation from Donors with Acute Kidney Injury Am J Transplant. 2017;17 (suppl 3).

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