Purpose

The use of kidneys from deceased donors with acute kidney injury (AKI) at the time of donation is a potential method by which to expand the donor pool. We investigated the outcomes of kidney transplantation (Tx) from donors with AKI, with a focus on fibrosis on protocol biopsies obtained during the first year post-Tx.

Methods

We identified 159 patients undergoing deceased donor kidney Tx between 2013 and 2016 with available information on donor kidney function and protocol biopsies. Donor, Tx, and recipient data were reviewed. Donor AKI was defined according to Acute Kidney Injury Network (AKIN) criteria, or by terminal serum creatinine ≥2 mg/dL. Banff interstitial fibrosis (ci 0-3) and tubular atrophy (ct 0-3) scores from 3 and 12 month post-Tx protocol biopsies were summed as IFTA score and compared between AKI and non-AKI donors using ordinal logistic regression.

Results

Twenty-eight (18%) patients received kidneys from donors with AKI (AKI group) and 131 (82%) received kidneys from donors without AKI (non-AKI group). Recipients of AKI and non-AKI kidneys were comparable for gender, age, race, BMI, diabetes, and pre-Tx dialysis (p>0.4 for all). There were no differences in donor gender, age, race, ECD or DCD status, cause of death, ischemia times, and number of HLA mismatches between AKI and non-AKI groups (p>0.4 for all). Post-Tx, the occurrence of delayed graft function was comparable (21% in AKI vs. 22% in non-AKI, p=0.93). At 1yr follow-up, creatinine (median [IQR]: 1.56 [1.1-2.1] in AKI, vs. 1.50 [1.2-2.0] in non-AKI, p=0.92) and GFR (45 [32-55] in AKI, vs. 41 [31-56] in non-AKI, p=0.98) were comparable. Donor AKI was not predictive of IFTA scores at 1yr (mean±SEM: 2.22±0.26 in AKI, vs. 2.00±0.09 in non-AKI, OR 1.08, 95% CI 0.43-2.70, p=0.86). Donor AKI was also not associated with progression of IFTA from 3 to 12 months (p=0.24). On multivariate analysis, which controlled for various risk factors pertinent to kidney Tx, the above associations held true.

Conclusion

The transplantation of kidneys from donors with mild AKI results in comparable kidney function, and similar degree of fibrosis on protocol biopsies obtained 1yr post-Tx. These kidneys are a valuable expansion of the donor pool for kidney Tx.

CITATION INFORMATION: van der Windt D., Chen X., Lemon K., Wu C., Shah N., Mehta R., Puttarajappa C., Sood P., Hariharan S., Ganoza A., Wijkstrom M., Humar A., Tevar A. Donor Acute Kidney Injury Does Not Affect Fibrosis on 1 Year Post-Transplant Kidney Biopsy Am J Transplant. 2017;17 (suppl 3).

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