Racial Differences in Acute Kidney Injury Occurrence among Deceased Kidney Donors
1University of Michigan, Ann Arbor, MI, 2University of Utah, Salt Lake City, UT, 3Columbia, New York, NY, 4Johns Hopkins, Baltimore, MD, 5University of Pennsylvania, Philadelphia, PA, 6Yale University, New Haven, CT, 7St. Barnabas, Livingston, NJ, 8Mount Sinai, New York, NY, 9University of Maryland, Baltimore, MD, 10Drexel, Philadelphia, PA, 11Cornell, New York, NY, 12University of Ulm, Ulm, Germany, 13Jefferson, Philadelphia, PA
Meeting: 2019 American Transplant Congress
Abstract number: B145
Keywords: African-American, Biopsy, Outcome, Renal ischemia
Session Information
Session Name: Poster Session B: Kidney Donor Selection / Management Issues
Session Type: Poster Session
Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Kidneys from African American (AA) deceased donors have lower graft survival than kidneys from white donors, regardless of recipient race. We hypothesized that kidneys from AA deceased donors are more susceptible to ischemia-reperfusion injury associated with organ procurement and transport, and are more likely to develop acute kidney injury (AKI), which may contribute to inferior recipient graft outcomes.
*Methods: We assembled a cohort of 1679 deceased donors enrolled by 5 procurement organizations from 2010-2013 as the Deceased Donor Study. We included all AA donors for whom we were able to identify a matched white donor based on age, sex, body mass index (BMI), donation after cardiac death (DCD) status, and admission serum creatinine (SCr). Donor AKI was assessed via: 1) change in SCr from admission to procurement with AKI severity classified by AKI Network criteria, 2) acute tubular injury (ATI) on procurement biopsy, and 3) donor urine AKI biomarkers (IL-18, KIM-1, NGAL, and YKL-40).
*Results: Our study consisted of 386 donors (193 AA and 193 white donors). Mean donor was 40±15 years, mean BMI was 28±7 kg/m2, and admission SCr 1.1±0.4 mg/dL. 58% of donors were male, and 7% met DCD criteria. Terminal SCr was higher in AA than white donors (1.3±0.8 vs. 1.2±0.9 mg/dL; p=0.04). Discard rates were similar between donor groups (p=0.89), 45% of donors had kidney biopsies in both groups, and urine biomarkers were measured in all donors. SCr-defined AKI occurred more often in AA donors than white donors (Overall: 35% vs. 24%; p=0.03, Stage 1: 25% vs. 17%, Stage 2: 6% vs. 2%, Stage 3: 4% vs. 5%). However, biopsy findings of ATI were less common in AA donor kidneys (21% vs. 28%, p=0.04). Donor urine AKI biomarker levels were not different between two groups, except for KIM-1, which was lower in AA donors (p=0.005). There was no effect modification by race and the association between SCr-defined AKI and urine biomarkers (IL-18 p=0.13; KIM-1 p=0.11, NGAL p=0.41, and YKL-40 p=0.62).
*Conclusions: Clinical AKI by SCr criteria is common among AA donors, but the frequency of histological ATI on procurement biopsy and levels of urine AKI biomarkers are comparable between AA and white donors. Due to the limited number of recipients in this study, we could not adequately determine whether kidneys from AA donors are less likely to recover after ischemia reperfusion injury, and could have worse graft outcomes.
To cite this abstract in AMA style:
Doshi M, Hall I, Mohan S, Liu C, Philbrook H, Reese P, Mansour S, Weng F, Akalin E, Bromberg J, Harhay M, Muthukumar T, Schroeppel B, Singh P, Parikh C. Racial Differences in Acute Kidney Injury Occurrence among Deceased Kidney Donors [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/racial-differences-in-acute-kidney-injury-occurrence-among-deceased-kidney-donors/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress