Background: Acute kidney injury (AKI) in the donor kidney may contribute to delayed graft function (DGF), heightened immunologic risk, and progressive graft fibrosis, thereby affecting long-term allograft function. Kidney biopsy allows for direct assessment of donor AKI at procurement. A small number of studies report conflicting results for associations between histologic acute tubular necrosis (ATN) and subsequent outcomes in transplant. We performed this multicenter study to determine the association of reported ATN in deceased donors with the development of DGF in recipients.
Methods: We examined detailed donor information along with kidney biopsy results from on-site pathologists obtained by 3 organ procurement organizations (OPOs) and linked these data with the United Network for Organ Sharing database. We calculated the relative risk (RR) for DGF with ATN controlling for the kidney donor risk index (KDRI), and given the significant interaction (P=0.02) of donation after cardiac death (DCD) on the association between ATN and DGF, we performed stratified analyses by DCD status.
Results: There were 635 kidneys with biopsy reports from 360 donors, with 63% male, 23% DCD, mean KDRI 1.47±0.38, age 50±13 years and cold ischemia 18±7 hours. ATN was similarly reported across OPOs and was noted in 107 kidneys (17%). DGF occurred more often in recipients of kidneys with reported ATN versus no ATN (47% vs. 36%, P=0.04), resulting in an overall RR (95% confidence interval) of 1.29 (1.02-1.62). RR was similar after adjusting for KDRI: 1.27 (1.0-1.61). In stratified analyses, RR was 1.12 (0.81-1.52) for non-DCD kidneys compared with 1.77 (1.35-2.31) for DCD kidneys.
Conclusion: Procurement kidney biopsy reports of ATN were modestly associated with the development of DGF in this observational cohort, especially for DCD kidneys. Additional research is needed to confirm this finding in other cohorts and to further elucidate the impact of donor AKI on longer-term allograft and recipient outcomes.
To cite this abstract in AMA style:Hall I, Reese P, Weng F, Schroppel B, Doshi M, Hasz R, Reitsma W, Goldstein M, Hong K, Parikh C. Deceased Kidney Donor Acute Tubular Necrosis and the Development of Delayed Graft Function [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/deceased-kidney-donor-acute-tubular-necrosis-and-the-development-of-delayed-graft-function/. Accessed February 26, 2020.
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