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Single Center Experience with “Extreme” Acute Kidney Injury Deceased Donor Kidneys

B. K. Sharda, M. Garner, A. Farney, G. Orlando, C. Jay, J. Rogers, A. Daniel, A. Gutierrez, N. Sakhovskaya, R. Stratta

Atrium Health Wake Forest Baptist Medical Center, Winston Salem, NC

Meeting: 2022 American Transplant Congress

Abstract number: 393

Keywords: Cadaveric organs

Topic: Clinical Science » Kidney » 32 - Kidney Deceased Donor Selection

Session Information

Session Name: Kidney Deceased Donor Selection II

Session Type: Rapid Fire Oral Abstract

Date: Tuesday, June 7, 2022

Session Time: 3:30pm-5:00pm

 Presentation Time: 3:50pm-4:00pm

Location: Hynes Ballroom C

*Purpose: Although many centers will consider transplanting kidneys from deceased donors (DD) with mild acute kidney injury (AKI), a markedly elevated terminal serum creatinine (tSCr) level remains a major reason for kidney discard following organ recovery. The study purpose was to review retrospectively our experience with transplanting kidneys from “extreme” AKI (eAKI) DDs.

*Methods: AKI kidneys were defined by a doubling of the DD’s admission SCr level and a tSCr level >2.0 mg/dl whereas eAKI kidneys were defined by a tSCr level ≥3.0 mg/dl. Dual kidney and multi-organ transplant recipients were excluded. All patients received depleting antibody induction and triple maintenance therapy (FK, MPA, steroids).

*Results: From 1/07 to 11/21, we transplanted 236 single AKI kidneys including 100 from DDs with a tSCr level ≥3.0 mg/dl. 49 AKI DDs had a tSCr level ≥4.0 and the remaining 51 had a tSCr level between 3.0-3.9 (overall mean 4.2 mg/dl) in the eAKI group. Mean donor and recipient ages were 32.8 and 50 years, respectively. Mean KDPI was 44%. 62 patients (62%) had at least 5-year follow-up. This eAKI group was compared to 996 concurrent control patients receiving kidneys from DDs with a tSCr <1.0 mg/dl (mean donor and recipient ages 42.6 and 53 years, respectively; mean KDPI 54%, mean tSCR 0.7 mg/dl). The incidence of delayed graft function (DGF, dialysis in first week) was 51% eAKI vs 29% in controls (p<0.0001) whereas the incidence of primary nonfunction (PNF) was 1% eAKI vs 2.6% controls (p=NS). One-year patient and kidney graft survival rates (GSR) were 98% vs 95% (p=NS) and 97% vs 91% (p=0.038) in the eAKI vs control groups, respectively. There were 2 early deaths in the eAKI group (respiratory failure at 3 months, cardiac event at 5 months) and the remaining early graft loss was secondary to PNF. With a mean follow-up of 79 months, overall patient and kidney GSRs were 84% vs 74% (p=0.029) and 71% vs 62% (p=0.08) in the eAKI vs control groups, respectively. Actual 5-year death-censored kidney GSRs were 85% eAKI vs 79% in controls (p=NS).

*Conclusions: In spite of a higher incidence of DGF, patients receiving kidneys from DDs with tSCr levels ≥3.0 mg/dl have excellent medium-term outcomes compared to those receiving kidneys from DDs with tSCr levels <1.0 mg/dl. Although a selection bias may exist for AKI DDs (lower donor age and KDPI), a high tSCr level should not be considered a contraindication to transplantation.

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To cite this abstract in AMA style:

Sharda BK, Garner M, Farney A, Orlando G, Jay C, Rogers J, Daniel A, Gutierrez A, Sakhovskaya N, Stratta R. Single Center Experience with “Extreme” Acute Kidney Injury Deceased Donor Kidneys [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/single-center-experience-with-extreme-acute-kidney-injury-deceased-donor-kidneys/. Accessed May 10, 2025.

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