Background– Organ scarcity and increased waiting times for kidney transplantation has led the transplant community to utilize more sub-optimal organs while continuing providing survival benefit to transplant recipients

In this study, our aim was to determine outcomes at our institution after transplanting kidneys from deceased donors with acute kidney injury (AKI) compared to donors without AKI

Methods:Retrospective single center transplant donor and recipient data analysis from chart review ranging 2014 to 2015. Donors were divided into the following 4 groups – No acute kidney injury (NAKIN), acute kidney injury grade 1, 2 or 3 (AKIN1, AKIN2, AKIN3), defined by creatinine level 1.5 times, 2 times and 3 times normal respectively. Our primary outcome was 1-year graft loss, other outcomes examined were delayed graft function (DGF), and recipient creatinine (Cr) at 1, 3 and 12 months after transplantation

Results-145 transplant recipients, 87 had NAKIN donors, and 58 had AKIN donors (17 AKIN1, 21 AKIN2 and 20 AKIN3). Mean donor terminal creatinine of NAKIN group was 1.05±0.77, AKIN1 was 2.32 ±0.77, AKIN2 was 3.33±1.67 and AKIN3 was 4.63±1.75. The mean recipient age of all groups were similar (NAKIN: 55±14, AKIN1: 55±17 AKIN2: 56±11 and AKIN3: 54±14). The rate for DGF was similar in all groups ( NAKIN 49/87, AKIN1 8/17, AKIN2 15/21 and AKIN3 11/20). After 1-year follow up AKIN 3 had no graft loss while graft loss in the NAKIN group was 1%(1/87), AKIN1 was 11%(2/17) and AKIN2 was 4%(1/21). Mean recipient creatinine at 1 year of AKIN1 and AKIN2 were not significantly different compared to NAKIN (2.16+/-0.59 and 1.74+/-0.14 versus 1.67+/-0.14 with p =0.1 and 0.7 respectively).Mean creatinine of AKIN3 was significantly lower than NAKIN (1.13 +/- 0.05, p<0.05). This could be due to the younger age of AKIN 3 donors (32y±16y) compared to NAKIN (41y±16), p=0.01, while AKIN1 and AKIN2 had similar donor ages to NAKIN (47y ± 16y and 41 ± 11 respectively).

Conclusions: Graft survival did not differ between recipients of donors with different degrees of AKI and non-AKI. Moreover, recipients of donors with severe AKI resulted in no graft loss and a better graft function at 1 year than all other recipients, likely related to their younger donor age and greater potential to recover form AKI. These outcomes are reassuring when considering young donors with severe acute kidney injury for transplantation.

CITATION INFORMATION: Channapatna Suresh S, Lubetzky M, Graham J, Chokechanaisakul A, Mohammed O, Kinkhabwala M, Akalin E, Rocca J, Bedi P. Kidney Transplantation Outcomes from Donors with Acute Kidney Injury. Am J Transplant. 2017;17 (suppl 3).

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