Beyond the Margin: Using Kidneys from Donors on Dialysis

P. S. Patel¹, S. Karir², V. R. Peddi¹, H. Mahanty¹, S. Katznelson¹, J. Bellingham¹, N. Neidlinger¹, A. Hassoun¹, A. Sandhu¹, N. Garg¹, L. Mayen³, W. Bry¹

¹CPMC Dept of Transplantation, San Francisco, CA, ²Lewis and Clark College, Portland, OR, ³Donor Network West, San Ramon, CA

Meeting: 2020 American Transplant Congress

Abstract number: 338

Keywords: Donors, marginal, Outcome, Renal failure, Resource utilization

Session Information

Session Name: Kidney Deceased Donor Selection II

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 4:03pm-4:15pm

Location: Virtual

*Purpose: Outcomes for transplantation from donors with acute kidney injury have been favorable. The definition and severity of AKI have been variable. Donors who are on acute dialysis represent the most severe form of AKI. We analyzed donor and recipient variables and kidney transplant outcomes using kidneys from donors with AKI who were receiving dialysis (AKI-D).

*Methods: Since November 2014, we performed 19 transplants from 18 donors with AKI-D. Donor data was extracted from DONOR NET and recipient data was extracted from our institutional OTTR and EPIC electronic medical records.

*Results: Mean donor age was 38 (21-51) and mean KDPI was 38 (5-68). Median duration of dialysis was 72 hours +/- 38.46 (mean 2.9 days) and 12 of 18 (66.6%) donors were anuric at procurement. 15 of the donors had drug overdose, PE or drowning. Half of the donor biopsies had no pathologic abnormality and findings on others were reported as mild, though changes of DIC or rhabdomyolysis were seen in 5 cases. 14 kidneys underwent machine perfusion. Of the 19 recipients over a follow up of 55 months, patient survival was 95% (18/19) and graft survival 90% (17/19). One graft and patient loss occurred following immunotherapy for metastatic melanoma and another with primary non-function related to multiple episodes of cellular and antibody mediated rejection. Of the 17 patients with a functioning graft, average serum creatinine is 1.17 mg/dL (0.71 – 2.2). Average pre-transplant duration of dialysis was 55 months (0 -204). Average length of stay was 6.4 days (4-15). 10/19 (53%) of patients were rehospitalized within 30 days of discharge. Average duration of dialysis post-transplant was 15 days (1 patient with primary non function was excluded).

*Conclusions: Kidneys from dialysis dependent donors represent a viable and underutilized option to expanding donor pool. The kidneys produced good long term graft outcomes albeit with higher resource allocation. We were the only center in our OPO to receive these kidney offers.

Recipient Characteristics
Patient Survival	95% (18/19)
Graft Survival	90% (17/19)
Creatinine	1.17 mg/dL (0.71-2.2)
Pre-transplant Duration of Dialysis	55 months (0-204)
Length of Stay	6.4 days (4-15)
Readmission Rate	53% (10/19)
Post-transplant Duration of Dialysis	15 days (0-45)
EPTS	37 (7-88)

Donor Characteristics
Age	38 (21-51)
Creatinine: Admit/High/Terminal	1.4/5.98/3.03 (last on RRT)
KDPI	38 (5-68)
Duration of RRT	2.9 days (16-120 hrs)
Anuric	12/18

To cite this abstract in AMA style:

Patel PS, Karir S, Peddi VR, Mahanty H, Katznelson S, Bellingham J, Neidlinger N, Hassoun A, Sandhu A, Garg N, Mayen L, Bry W. Beyond the Margin: Using Kidneys from Donors on Dialysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/beyond-the-margin-using-kidneys-from-donors-on-dialysis/. Accessed November 22, 2024.

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