Kidney Transplantation (KTx) Using Kidneys from Deceased Donors (DD) with Severe Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy (RRT)
Mayo Clinic, Phoenix.
Meeting: 2018 American Transplant Congress
Abstract number: D120
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:
Transplant centers are reluctant to accept kidneys from DD with severe AKI necessitating utilization of RRT. The aim of this study is to determine the outcomes with KTx from DD with severe AKI requiring RRT.
Methods:
We included all KTx from DD at our center between 2008 and 09/2017. We discarded 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) and to determine if the DD required RRT pre-procurement. The primary outcome is graft survival including death. The comparison group is DD with AKIN 3 not requiring RRT.
Results
We were able to determine the AKIN stage in 1193 (83.7%) of the DD KTx during this period. 424 (35.5%) had AKIN stage 3. There were 72 (17%) who required RRT (58 hemodialysis (HD) and 14 continuous renal replacement) and 351 with AKIN 3 who did not require RRT. There were no significant differences in the recipient characteristics. In the RRT group, the donors were young (31.4 (12.8) vs. 37.7 (14.2), p=0.0005), had lower KDPI (40.9 (22.4) vs. 54.0 (22.6), p<0.0001) and longer cold ischemic time (CIT).
Delayed graft function (DGF) was more common in the RRT group (90.3 vs 73.2%, p=0.0008). The eGFR at 1 year was similar (RRT vs control, 62.0 (20.0) vs. 59.4 (22.0), p=0.45). Median (IQR) years follow up was 2.8 (1.1-4.5) in the RRT and 2.0 (1.2-3.6) in the control group (p=0.34). Graft survival was similar (log rank p=0.90). Graft survival at 3 years was 91.1% in the RRT group and 90.7% in the control group. Graft loss during the first 90 days post KTx was also similar (p=0.73 by log rank).
Conclusions:
With careful selection, kidneys from DD with severe AKI requiring RRT can be transplanted with excellent outcomes and is not an absolute contraindication to KTx.
CITATION INFORMATION: Srinivasan A., Heilman R., Kumar A., Khamash H., Smith M., Reddy K., Moss A. Kidney Transplantation (KTx) Using Kidneys from Deceased Donors (DD) with Severe Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy (RRT) Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Srinivasan A, Heilman R, Kumar A, Khamash H, Smith M, Reddy K, Moss A. Kidney Transplantation (KTx) Using Kidneys from Deceased Donors (DD) with Severe Acute Kidney Injury (AKI) Requiring Renal Replacement Therapy (RRT) [abstract]. https://atcmeetingabstracts.com/abstract/kidney-transplantation-ktx-using-kidneys-from-deceased-donors-dd-with-severe-acute-kidney-injury-aki-requiring-renal-replacement-therapy-rrt/. Accessed May 16, 2025.« Back to 2018 American Transplant Congress