*Purpose: In the current scenario of shortage of donor organs, kidneys with AKI are being used and outcome research reports show that the outcomes could be worse depending on the severity of donor AKI. However, not much is known about the molecular response patterns post-transplant and the pathways involved. This study is focused on the study of the influence of donor AKI on reperfusion injury and early post-transplant molecular response at 3months.

*Methods: A total of 66 renal allograft from recipients from deceased donors without and with different severity of AKI were studied. Gene expression arrays for pre-implantation (PI), and post-reperfusion (PR) and 3 months post-transplant (K3mo) were performed and analyzed. Gene enrichment analysis and pathway analysis was done.

*Results: Overall, exacerbated inflammation was observed immediately post-transplantation in all grafts. The differences were mainly related to pre-existing molecular profiles as the comparison of PI and PR molecular responses between donor non-AKI group and AKI group were not different but the PR patterns between allografts with and without AKI showed huge differences in terms of metabolic and inflammatory response. Comparing 3 months post-transplant profiles between allograft biopsies showed metabolic genes down regulated in those who had AKI donors. Also genes involved in repair, mainly growth factors like FGF9, NODAL, PGF, NENF were down regulated while the upregulated arm involved pro-inflammatory cytokines and growth factors and transcription factors that exacerbate inflammatory response.

*Conclusions: Recipients of kidneys with pre-existing AKI have molecular characteristics of molecular injury and impaired repair.The better understanding on these mechanisms may help to develop therapies to achieve improved function .

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