Background: Our aim was to determine the outcome of transplanting kidneys from selected donors with severe AKI.
Methods: We selected all patients receiving single organ deceased donor kidney transplant at our center transplanted between June 2004 and October 2012. Terminal creatinines (Cr) for all donors were obtained from UNOS. AKI donor was defined as a donor terminal Cr > 2.0. Donor data was obtained from UNET. The acute kidney injury network criteria (AKIN) were used to stage the severity of the AKI in the donor (stage 1 to 3 with 3 requiring Cr 3 times baseline elevation or increase Cr ≥ 4 or urine output < 0.3 ml/kg for > 24 hours or anuria > 12 hours). Continuous variables are given as mean± 1 SD.
Results: There were 104 in the AKI group and 501 in the non AKI group. Baseline characteristics were similar, except AKI group had longer cold ischemia time (19.8±7.8 vs. 15.6±7.2, p<0.0001), were more likely to be male (76% vs. 57%, p=0.02). HLA mismatch was higher in the AKI group (4.1±1.7 vs. 3.6±2.0, p=0.03). Characteristics of the donors in the AKI group: peak Cr 4.02±1.84, terminal Cr 3.53±1.62, oligoanuric in 39%, renal replacement therapy in 10%. Pulsatile pump was used more often in the AKI group (61% vs. 23%, p<0.0001). Delayed graft function (DGF) was more frequent in the AKI group (69% vs. 27%, p<0.0001). The Cr at 1 week was higher in the AKI group (4.26±2.18 vs. 2.66±1.95, p<0.0001) but Cr and eGFR at 1 year (yr) were similar. 1 yr protocol biopsy (Bx) findings were not significantly different. Actuarial graft survival was similar at 1 and 3 yr (AKI 92% and 88%, non AKI 92% and 86%). For the AKI group, the kidneys from donors with AKIN stage 3 were more likely to have DGF and a higher Cr at 1 week, but eGFR and Bx findings at 1 yr were similar (table).
|All Kidneys||AKI kidneys only|
|Non AKI Donor (n=501)||AKI donors (n=104)||P||AKIN<3 (n=32)||AKIN 3 (n=64)||P|
|Cr at 1 week||2.66±1.95||4.26±2.18||<0.0001||3.47±2.20||4.65±2.08||0.01|
|Cr 1 month||1.72±1.02||1.84±1.22||0.32||1.85± 1.57||1.84± 1.01||0.97|
|eGFR 1 year||60.0±22.6 (n=328)||60.2±21.9 (n=54)||0.94||58.1±21.8 (n=20)||60.7±20.5 (n=29)||0.70|
|ci>1 on 1 yr Bx||30% (n=264)||40% (n=43)||0.23||36% (n=11)||38% (n=26)||1.0|
Conclusion: Kidneys from AKI donors, including carefully selected donors with severe AKI, have similar outcomes to non AKI donor kidneys. More liberal use of these organs will help relieve the organ shortage.
To cite this abstract in AMA style:Heilman R, Khamash H, Huskey J, Smith M, Katariya N, Moss A, Mulligan D, Reddy K. Excellent Outcome Following Transplant Using Kidneys from Deceased Donors with Severe Acute Kidney Injury [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/excellent-outcome-following-transplant-using-kidneys-from-deceased-donors-with-severe-acute-kidney-injury/. Accessed April 7, 2020.
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