Session Name: Kidney Deceased Donor Selection
Session Date & Time: None. Available on demand.
*Purpose: Older patients are perceived to tolerate delayed graft function (DGF) poorly and there is a reluctance to transplant a kidney from an AKI donor into older recipients. Our aim was to examine the outcomes of older transplant recipients (age ≥65years) receiving kidneys from donors with AKI.
*Methods: We included all patients ≥65 years of age who received deceased donor kidney transplants from 2/1/08 – 12/29/19 at our center. We used acute kidney injury network (AKIN) criteria to assess the severity of AKI in the donors. Patients who received kidneys from donors with AKIN2-3 were compared to those receiving kidneys from AKIN0-1 donors. The primary outcomes were patient survival, all-cause and death-censored graft survival.
*Results: Of the 594 patients who received kidney transplant at our center during the study period 265 received AKIN 2-3 kidneys and 329 received AKIN 0-1 kidneys. Baseline characteristics were similar between the 2 groups. AKIN 2-3 had a lower KDPI (58 Vs 68), younger donor age (43 Vs 51) and lower % of DCD kidneys (12 VS 23%). DGF rate was higher in the AKIN 2-3 group (65% vs 45%). The patient survival, graft survival, death censored graft survival, 1 year GFR and rejection rate were not significantly different. Biopsies at 1 year showed no significant difference for acute or chronic changes (table 2). Death with functioning graft was the most common cause for graft failure in both groups (67.4% AKIN0-1 Vs 69.8% AKIN2-3). 4 cases of primary non function (PNF) were seen in AKIN0-1 Vs 3 in AKIN2-3.
*Conclusions: Despite higher rate of DGF, recipients ≥ 65 tolerate AKIN 2-3 kidneys well and have equivalent outcomes to those receiving AKIN 0-1 kidneys. As expected, death with functioning graft is the primary cause for graft loss in older recipients. Older recipients should not be excluded from receiving kidneys from severe AKI donors.
To cite this abstract in AMA style:Nair S, Reddy K, Kodali L, Budhiraja P, Ninan J, Jadlowiec C, Mathur A, Harbell J, Khamash H, Smith M, Heilman R. Outcomes in Older Recipients Receiving Kidneys from Donors with Acute Kidney Injury (AKI) [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-in-older-recipients-receiving-kidneys-from-donors-with-acute-kidney-injury-aki/. Accessed June 12, 2021.
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