Trends in the Recovery and Discard of Kidneys from Deceased Donors with Acute Kidney Injury from 2010-2018

C. Liu¹, S. Alasfar², P. P. Reese³, S. Mohan⁴, M. D. Doshi⁵, I. E. Hall⁶, H. R. Thiessen-Philbrook², Y. Jia², D. E. Stewart⁷, C. Parikh²

¹Icahn School of Medicine at Mount Sinai, New York, NY, ²Johns Hopkins University School of Medicine, Baltimore, MD, ³Perelman School of Medicine, Philadelphia, PA, ⁴New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, ⁵University of Michigan, Ann Arbor, MI, ⁶University of Utah School of Medicine, Salt Lake City, UT, ⁷United Network for Organ Sharing, Richmond, VA

Meeting: 2021 American Transplant Congress

Abstract number: 849

Keywords: Donors, marginal, Kidney transplantation, Renal function, Renal injury

Topic: Clinical Science » Kidney » Kidney Deceased Donor Selection

Session Information

Session Name: Kidney Deceased Donor Selection

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Since the donor KDPI score used in KAS is restricted to a single terminal serum creatinine (SCr) measurement, kidneys from donors with transient acute kidney jury (AKI) may have misleadingly high KDPI scores. We characterized trends in the recovery and discard of kidneys from deceased donors with AKI in the context of KAS implementation.

*Methods: We retrospectively analyzed 71,180 donors in the OPTN database >16 years of age who had at least one organ recovered for transplant between 1/1/2010-1/1/2019. AKI was defined as ≥50% or ≥0.3 mg/dL increase in terminal SCr from admission. AKI stages were defined by KDIGO guidelines. The primary outcomes were kidney recovery and discard rates. We estimated the change in discard rate following KAS implementation (in 12/2014) with interrupted time series adjusted for secular trends.

*Results: Of 130,506 kidneys recovered, 25,982 (20%) were not utilized, half (12,780) of which were from donors with AKI. The proportion of donors with any AKI did not change significantly (~38%) during this time frame. The proportion of donors with stage 3 AKI increased from 6% (412/6841 donors) in 2010 to 11% (1056/9575 donors) in 2018. The kidney recovery rate did not change significantly from 2010-2018 among lower stages of AKI. The recovery rate of kidneys from donors with stage 3 AKI kidneys increased from 51% (423/824 kidneys) in 2010 to 62% (1488/2112 kidneys) in 2018. Discard of recovered stage 3 AKI kidneys decreased from 41% (175/423 kidneys) in 2010 to 32% (153/481 kidneys) in 2012 but increased after KAS implementation by 7% and remained high at 42% (619/1488 kidneys) in 2018 (Figure). The number of centers transplanting >5% stage 3 AKI kidneys increased from 6% (32/493) in 2010 to 15% (75/493) in 2018.

*Conclusions: KAS may have contributed to the increased discard rate of stage 3 AKI kidneys. Concurrent increases in discard and transplantation of stage 3 AKI kidneys suggest increasing recovery that outpaces transplantation.

To cite this abstract in AMA style:

Liu C, Alasfar S, Reese PP, Mohan S, Doshi MD, Hall IE, Thiessen-Philbrook HR, Jia Y, Stewart DE, Parikh C. Trends in the Recovery and Discard of Kidneys from Deceased Donors with Acute Kidney Injury from 2010-2018 [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/trends-in-the-recovery-and-discard-of-kidneys-from-deceased-donors-with-acute-kidney-injury-from-2010-2018/. Accessed May 11, 2025.

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