Kidney Transplantation (KTx) Using Kidneys from Deceased Donors (DD) with AKIN Stage 2 and 3 Are Associated with Excellent Graft Outcomes

A. Kumar, K. Reddy, A. Srinivasan, J. Huskey, H. Khamash, M. Smith, A. Moss, R. Heilman.

Mayo Clinic, Phoenix.

Meeting: 2018 American Transplant Congress

Abstract number: D119

Keywords: Donors, Graft function, marginal

Session Information

Session Name: Poster Session D: Kidney Donor Selection / Management Issues

Session Type: Poster Session

Date: Tuesday, June 5, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Background

KTx from DD with AKI can be a good source of kidneys however these kidneys are underutilized. The aim of this study is to determine the outcomes after KTx from DD with AKIN stage 2 and 3 AKI.

Methods

We included KTx from DD at our center between 2008 and 9/2017. We discard kidneys with more than 10% cortical necrosis or more than mild chronic changes on pre-implantation biopsy. We extracted data from DonorNet in order to classify the severity of AKI using the AKIN staging system (stage 0-3). The primary outcome is graft survival including death for AKIN 2-3 compared to AKIN 0-1.

Results

We were able to determine the AKIN stage in 1193 (83.7%) of the DD KTx during this period. 593 (49.7%) were AKIN stage 2-3. The AKIN 2-3 group was more likely diabetic and on dialysis pre KTx. AKIN 2-3 group donors were younger (38.1 (14.8) vs. 42.7 (18.9), p<.01) more likely male and black race and had lower KDPI (51.8 (24.0) vs. 55.9 (27.9),p=0.01). DGF was more common in the AKIN 2-3 group (67.1% vs. 32.0%, p<.0001). Median (IQR) years follow up was 2.8 (1.4-4.5) in the AKIN 2-3 group and 3.9 (1.5-6.1) in the AKIN 0-1 group. Even after controlling for the baseline differences, graft survival was better in the AKIN 2-3 group (HR 0.67, 95% CI 0.49-91-0.94). The eGFR at 1 year was higher in the AKIN 2-3 group.

	AKIN 0-1	AKIN 2-3	P
eGFR 1 year [mean (SD)]	55.0( 20.9)	59.0( 21.3)	<0.01
Acturial 3 year graft survival ( %)	83.8	90.1	0.02
Number at risk at 3 years	369	274

AKIN 0-1 AKIN 2-3 P

eGFR 1 year [mean (SD)] 55.0( 20.9) 59.0( 21.3) <0.01

Acturial 3 year graft survival ( %) 83.8 90.1 0.02

Number at risk at 3 years 369 274

Reperfusion biopsies (RBx) were available in 65.8% of the AKIN 2-3 group and 62.3% in the AKIN 0-1 group. There were less chronic changes in the AKIN 2-3 group (e.g., %ci> 0: 17.3 vs. 34.2, p=0.02).

Conclusions

KTx from DD with AKIN stage 2-3 is associated with excellent graft survival and GFR. RBx showed less chronic changes in the AKIN 2-3 group. These findings suggest that our selection process for accepting DD with severe AKI is effective. More study of the value of pre-implantation biopsy in the selection process for AKI kidneys is necessary.

CITATION INFORMATION: Kumar A., Reddy K., Srinivasan A., Huskey J., Khamash H., Smith M., Moss A., Heilman R. Kidney Transplantation (KTx) Using Kidneys from Deceased Donors (DD) with AKIN Stage 2 and 3 Are Associated with Excellent Graft Outcomes Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Kumar A, Reddy K, Srinivasan A, Huskey J, Khamash H, Smith M, Moss A, Heilman R. Kidney Transplantation (KTx) Using Kidneys from Deceased Donors (DD) with AKIN Stage 2 and 3 Are Associated with Excellent Graft Outcomes [abstract]. https://atcmeetingabstracts.com/abstract/kidney-transplantation-ktx-using-kidneys-from-deceased-donors-dd-with-akin-stage-2-and-3-are-associated-with-excellent-graft-outcomes/. Accessed May 16, 2025.

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