Short-term outcomes after transplantation of deceased donor kidneys with acute kidney injury: a retrospective analysis of a multicenter cohort of marginal donor kidneys with post-explantation biopsies

Abstract

Background Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies. Methods This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated. Results Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; ORStage 1: 1.435 (95% CI 0.438–0.702), ORStage 2: 2.463 (95% CI 0.656–9.245), ORStage 3: 4.784 (95% CI 1.421–16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates. Conclusion The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.

Single center experience and literature review of kidney transplantation from non‐ideal donors with acute kidney injury: Risk and reward

“… 36 Conversely, a study from Germany analyzed outcomes from donors ≥65 years of age with or without AKI and noted no differences in renal function or survival outcomes (Table 7). 40 Another study from Germany concluded that histopathological assessment of non‐ideal donor kidneys with AKI was not helpful in predicting outcomes 73 …”

“…40 Another study from Germany concluded that histopathological assessment of non-ideal donor kidneys with AKI was not helpful in predicting outcomes. 73 Based on a number of studies from 2005 to 2007 that showed acceptable short-term outcomes with AKI kidneys from highly selected SCDs, and an increasing number of available AKI donor kidneys, we initiated a programmatic change in January 2007 to begin utilizing AKI donor kidneys. [21][22][23]41,42 We have previously reported our experience with AKI donor kidney transplantation with short and long-term follow-up as well as our experience using AKI donor kidneys with prolonged CIT.…”

Impact of Deceased-donor Acute Kidney Injury on Kidney Transplantation

“…34 Similarly, none of the studies we summarized in Table 1 have reported increased acute rejection rates in AKI donor recipients. 9,[12][13][14]20,[22][23][24] Furthermore, Budhiraja et al 35 studied the impact of DGF duration on transplant outcomes, and on multivariate analysis, donor AKIN stage of ≥2 was not associated with DGF duration. As such, transitively, worsening AKI stage should not contribute to longer duration of DGF and this should not contribute to increased risk of acute rejection.…”

“…As expected, most studies documented higher DGF in deceased donors with AKI. 6,8,9,[12][13][14][15]17,18,20,24 However, there is mixed data in the literature as to the relationship of DGF to short-and longterm graft outcomes, allograft function, and acute rejection.…”

“…Scurt et al 12 reported that recipients of kidneys with AKIN stage 3 had an increased rate of DGF (OR, 4.78; 95% CI, 1.42-16.1) but similar death-censored graft survival and patient survival compared with non-AKI donors and those with AKIN stage 1 and 2.…”