Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

Benck, Urs; Schnuelle, Peter; Krüger, Bernd; Nowak, Kai; Riester, Thomas; Mundt, Heiko; Lutz, Niklas; Jung, Matthias; Birck, Rainer; Krämer, Bernhard K.; Schmitt, Wilhelm H.

doi:10.1007/s11255-015-1127-5

Cited by 20 publications

(20 citation statements)

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“…In light of the overall evidence supporting the use of AKI kidneys across studies, [17][18][19][20][21][22][23][24][25][26] the concerns raised by the registry study 48…”

Section: Discussionmentioning

confidence: 99%

Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival

et al. 2020

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IMPORTANCE The shortage of deceased donor kidneys for transplants is an ongoing concern. Prior studies support transplanting kidneys from deceased donors with acute kidney injury (AKI), but those investigations have been subject to selection bias and small sample sizes. Current allocation practices of AKI kidneys in the United States are not well characterized. OBJECTIVES To evaluate the association of deceased donor AKI with recipient graft survival and to characterize recovery and discard practices for AKI kidneys by organ procurement organizations.

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“…In light of the overall evidence supporting the use of AKI kidneys across studies, [17][18][19][20][21][22][23][24][25][26] the concerns raised by the registry study 48…”

Section: Discussionmentioning

confidence: 99%

Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival

et al. 2020

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“…There is only limited retrospective data on the outcome of kidneys with donor AKI in Germany [12–14]. All studies are small and have several limitations i.e.…”

Section: Introductionmentioning

confidence: 99%

Expanding the donor pool in kidney transplantation: Should organs with acute kidney injury be accepted?—A retrospective study

et al. 2019

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BackgroundGiven the gap between patients in need of a renal transplantation (RTx) and organs available, transplantation centers increasingly accept organs of suboptimal quality, e.g. from donors with acute kidney injury (AKI).MethodsTo determine the outcome of kidney transplants from deceased donors with AKI (defined as ≥ AKIN stage 1), all 107 patients who received a RTx from donors with AKI between August 2004 and July 2014 at our center were compared to their respective consecutively transplanted patients receiving kidneys from donors without AKI. 5-year patient and graft survival, frequencies of delayed graft function (DGF), acute rejections and glomerular filtration rate (eGFR, CKD-EPI) were assessed.ResultsPatient survival was similar in both groups, whereas death-censored and overall graft survival were decreased in AKI kidney recipients. AKI kidney recipients showed higher frequencies of DGF and had a reduced eGFR at 7 days, three months and one and three years after RTx. However, mortality was noticeably lower compared to waiting list candidates. Rejection-free survival was similar between groups.ConclusionsIn our cohort, both short-term and long-term renal function was inferior in recipients of AKI kidneys, while patient survival was similar. Our data indicates that recipients of donor AKI kidneys should be carefully selected and additional factors impairing short- and long-term outcome should be minimized to prevent further deterioration of graft function.

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“…Although donation after circulatory death (DCD) is associated with significantly higher incidences of DGF, midterm survival of DCD kidneys is comparable to those from DBD . There is accumulating evidence that AKI occurring under warm circulatory conditions in the DBD, and progressing to DGF after transplantation hardly worsens midterm graft outcomes . A large register‐based study from the United Kingdom reported a 2% reduction only in 1‐year kidney graft survival from donors with AKI .…”

Section: Discussionmentioning

confidence: 99%

Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

Schnuelle

Mundt

Drüschler

et al. 2018

American Journal of Transplantation

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A previous donor intervention trial found that therapeutic hypothermia reduced delayed graft function (DGF) after kidney transplantation. This retrospective cohort study nested in the randomized dopamine trial (ClinicalTrials.gov identifier: NCT000115115) investigates the effects of spontaneous donor hypothermia (core body temperature <36°C) on initial kidney graft function, and evaluates 5-year graft survival. Hypothermia assessed by a singular measurement in the intensive care unit 4-20 hours before procurement was associated with less DGF after kidney transplantation (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.34-0.91). The benefit was greater when need for more than a single posttransplant dialysis session was analyzed (OR 0.48, 95%CI 0.28-0.82). Donor dopamine ameliorated dialysis requirement independently from hypothermia in a temporal relationship with exposure (OR 0.93, 95%CI 0.87-0.98, per hour). A lower core body temperature in the donor was associated with lower serum creatinine levels before procurement, which may reflect lower systemic inflammation and attenuated renal injury from brain death. Despite a considerable effect on DGF, our study failed to demonstrate a graft survival advantage (hazard ratio [HR] 0.83, 95%CI 0.54-1.27), whereas dopamine treatment was associated with improved long-term outcome (HR 0.95, 95%CI 0.91-0.99 per hour).

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Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

Abstract: Kidneys from AKI donors can be transplanted with excellent intermediate prognosis and should not be discarded.

Cited by 20 publications

References 20 publications

Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival

Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival

Expanding the donor pool in kidney transplantation: Should organs with acute kidney injury be accepted?—A retrospective study

Impact of spontaneous donor hypothermia on graft outcomes after kidney transplantation

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