Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death

Tomita, Yusuke; Iwadoh, Kazuhiro; Ogawa, Yuichi; Miki, Katsuyuki; Kai, Kotaro; Sannomiya, Akihito; Murakami, Toru; Koyama, Ichiro; Kitajima, Kumiko; Nakajima, Ichiro; Fuchinoue, Shohei

doi:10.1097/txd.0000000000000768

Cited by 8 publications

(9 citation statements)

References 38 publications

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“…Most of these patients had good renal function after the first month of transplantation, as occurred with our patients, and adequate long-term graft survival. 12 It is possible to argue that all three donors in this study had AKI for rhabdomyolysis. In a retrospective observational study carried out by Chen et al, they analyzed 30 patients diagnosed with KDIGO III AKI kidneys during rhabdomyolysis, compared to 90 patients who received standard kidneys, and they reported that there was no statistical difference in relation to creatinine and GFR at months 2, 6, 12 and 24; there was also no difference in the incidence of rejection, 13 showing good graft function in the long term.…”

Section: Discussionmentioning

confidence: 84%

Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

et al. 2019

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Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.

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Section: Discussionmentioning

confidence: 84%

Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

et al. 2019

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“…However, several experiences reported from DCD donors with pre‐arrest renal failure or prolonged warm ischemia as well as brain‐dead SCDs with high or rising SCr levels at the time of organ recovery have challenged this notion. In some instances, the use of AKI donor kidneys has been successfully extended to include selected ECDs, high KDPI donors, donors ≥ 65 years of age, and DDs on temporary renal replacement therapy 48–58 . Unfortunately, many AKI DD kidneys are declined by local centers, which results in delays in placement and increases CIT 41,59–62 .…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of kidney transplantation from deceased donors with terminal acute kidney injury: Single center experience and literature review

Garner

Jay

Sharda

et al. 2022

Clinical Transplantation

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Introduction Long‐term outcomes of kidney transplantation from deceased donors (DDKTs) with terminal acute kidney injury (AKI) are not well defined. Methods Single center retrospective review of DDKTs from 1/31/07‐12/31/19. AKI kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level AND a terminal SCr ≥2.0 mg/dl. Results A total of 188 AKI DDKTs were performed, including 154 from brain‐dead standard criteria donors (SCD). Mean donor age was 36 years and mean Kidney Donor Profile Index was 50%; mean admission and terminal SCr levels were 1.3 and 3.1 mg/dl, respectively. With a mean follow‐up of 94 months (median 89 months), overall patient (both 71.3%) and graft survival (54% AKI vs. 57% non‐AKI) rates were comparable to concurrent DDKTs from brain‐dead non‐AKI SCDs (n = 769). Delayed graft function (DGF) was higher in AKI kidney recipients (47% vs. 20% non‐AKI DDKTs, p < .0001). DGF was associated with lower graft survival in recipients of both AKI and non‐AKI SCD kidneys but the impact was earlier and more pronounced in non‐AKI recipients. Conclusions Despite having more than twice the incidence of DGF, kidneys from deceased donors with terminal AKI have long‐term outcomes comparable to non‐AKI SCD kidneys and represent a safe and effective method to expand the donor pool.

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“…Kidneys with acute kidney injury (AKI) from deceased donors are considered marginal donor kidneys (7)(8)(9)(10). Serum creatinine is a common clinical indicator of AKI, and the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes) criteria all use it as a biomarker (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Combining Clinical Parameters and Acute Tubular Injury Grading Is Superior in Predicting the Prognosis of Deceased-Donor Kidney Transplantation: A 7-Year Observational Study

Wang

Liu

et al. 2022

Front. Immunol.

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BackgroundWe developed a pragmatic dichotomous grading criterion to stratify the acute tubular injury (ATI) of deceased-donor kidneys. We intended to verify the predictive value of this criterion for the prognosis of deceased-donor kidney transplantation.MethodsThe allografts with ATI were classified into severe and mild groups. Severe ATI was defined as the presence of extreme and diffuse flattening of the tubular epithelial cells, or denudement of the tubular basement membrane. The clinical delayed graft function (DGF) risk index was calculated based on a regression model for posttransplant DGF using 17 clinical parameters related to donor–recipient characteristics.ResultsA total of 140 recipients were enrolled: 18 severe and 122 mild ATI. Compared with the mild ATI group, the severe ATI group had more donors after cardiac death, higher median donor terminal serum creatinine level (dScr), and longer median cold ischemia time. Severe ATI had a higher DGF rate (55.6% vs 14.6%, p < 0.001), longer DGF recovery time (49.6 vs 26.3 days, p < 0.001), and a lower estimated glomerular filtration rate (eGFR) at 1 month (23.5 vs 54.0 ml/min/1.73 m2, p < 0.001), 3 months (40.4 vs 59.0, p = 0.001), and 6 months after transplant (46.8 vs 60.3, p = 0.033). However, there was no significant difference in eGFR at 1 year or beyond, graft, and patient survival. The predictive value of combined dScr with ATI severity for DGF rate and DGF recovery time was superior to that of dScr alone. The predictive value of the combined DGF risk index with ATI severity for DGF was also better than that of the DGF risk index alone; however, the association of the DGF risk index with DGF recovery time was not identified. Chronic lesions including glomerulosclerosis, interstitial fibrosis, arterial intimal fibrosis, and arteriolar hyalinosis were associated with declined posttransplant 1-year eGFR.ConclusionBased on our pragmatic dichotomous grading criterion for ATI in a preimplantation biopsy, donor kidneys with severe ATI increased DGF risk, prolonged DGF recovery, and decreased short-term graft function but demonstrated favorable long-term graft function. Our grading method can offer additive valuable information for assessing donor kidneys with acute kidney injury and may act as an effective supplementary index of the Banff criteria.

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Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death

Cited by 8 publications

References 38 publications

Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

Long‐term outcomes of kidney transplantation from deceased donors with terminal acute kidney injury: Single center experience and literature review

Combining Clinical Parameters and Acute Tubular Injury Grading Is Superior in Predicting the Prognosis of Deceased-Donor Kidney Transplantation: A 7-Year Observational Study

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