Background: Iodine contrast exposure is well known to cause acute kidney injury. When contrast exposure is added to hemodynamic ischemic injury its adverse effects on tubular injury can be greatly increased. Donors prior to procurement tend to receive multiple test imaging that include use of iodine contrast. We sought to evaluate the association of iodine contrast exposure in deceased kidney transplant donors prior to procurement and kidney transplant outcomes.

Methods: Using data from the Organ Procurement and Transplantation Network, we evaluate whether patients receiving organs for donors who received a coronary angiogram prior to organ recovery have delayed graft function post-transplant. We use multivariate regression analysis to analyze the effect of donor coronary angiograms on a variety of measures of delayed graft function using data on patients who received transplants between May 1, 2000 to December 31, 2012, controlling for time-invariant factors affecting all patients in a given year (year fixed effects) and time-varying factors associated with a specific transplant center (center fixed effects). (Standard errors are clustered at the center level to account for heteroskedasticity and spatial correlation among patients in a given center.)

Results: Of the total of donors, 8012 received a coronary angiogram, with 88% transplant rate for their kidneys. Of these donors a total of 14 6282 kidneys were transplanted. Statistically significant regression results (p<0.01) indicate that patients receiving organs from donors who received coronary angiograms are two percentage points more likely to receive dialysis within the first week post-transplant (mean=0.24) and are less likely to experience a greater than twenty-five percent decline in creatinine levels within one week post-transplant (mean=0.56). These patients also face a sixty-one day shorter average graft survival time and a one percentage point lower probability of six month post-transplant survival.

Conclusions: Use of iodine contrast for coronary angiogram pre organ procurement is associated with adverse kidney transplant outcomes that appears to be beyond the the initial period. This findings warrants further research to study more in depth this association and the biologic mechanisms that could explain adverse outcomes.

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