Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Jiang, Yamei; Song, Ting; Liu, Jinpeng; Wang, Zhong Lin; Wang, Xianding; Huang, Zhongli; Fan, Yu; Lin, Tao

doi:10.1111/petr.13326

Cited by 11 publications

(12 citation statements)

References 32 publications

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“…Prior research on the utilization of pediatric deceased donors with AKI was limited. Jiang et al [25] found that transplants procured from pediatric AKI donors have a comparable renal function and an excellent patient and graft survival rate, but they found a similar incidence of DGF, which is different from our study. In contrast, our study consists with another study includes very small (≤15 kg) pediatric donors with AKI and found that AKI can impact early post-transplant kidney graft function (e.g., the rate of DGF), but it did not increase the risk of early graft loss or decreased renal function in the long term [18] .…”

Section: Discussioncontrasting

confidence: 99%

“…The presence of AKI in organ donors appears to impact the willingness to accept and transplant donor kidneys in China [25] . The incidence rate of AKI ranges from 25% to 52% within pediatric intensive care units [26,27] , and to augment the donor pool with systematic analysis of kidney transplants from pediatric donors with AKI, we found that although the incidence of DGF was higher in recipients of allografts with AKI, deceased donor AKI status itself did not affect death-censored graft and recipient survival.…”

Section: Discussionmentioning

confidence: 99%

“…This was a large-scale clinical cohort study. Previous research [18,25] has been limited by less observation time or small sample sizes, particularly for the number of pediatric deceased donors with stages 2 and 3 AKI. Second, we con rmed our research by comparing early clinical outcomes between the pediatric and adult cohorts in detail.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Liu

Zhang

Zhong

et al. 2022

Preprint

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Background: The use of kidneys from deceased donors with acute kidney injury (AKI) to expand the donor pool is an ongoing trend. Prior research on the utilization of AKI donor kidneys, especially from pediatric AKI donors, was limited and has been subject to small sample sizes. In this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI. Methods: This retrospective study compared the clinical results (including delayed graft function [DGF], acute rejection, patient and death-censored graft survival rates and renal function post-transplant) of kidney transplantation from deceased donors who were categorized as pediatric donors and adult donors with or without AKI, as defined by the Kidney Disease: Improving Global Outcomes (KIDGO) criteria, at our center between January 2018 and December 2020. Results: Of the 740 patients, 154 received kidneys from pediatric donors (with AKI group [n=41]; without AKI group [n=113]), and 586 received kidneys from adult donors (with AKI group [n=218]; without AKI group [n=368]). The baseline characteristics were similar in both cohorts. No significant difference was observed in 1-year patient survival, death-censored graft survival, or acute rejection between the AKI and non-AKI groups in both the pediatric and adult cohorts. However, compared with those transplanted with adult AKI kidneys, those transplanted with pediatric AKI kidneys showed a superior recovery of allograft function. In pediatric cohorts, no significant difference was found in serum creatinine/estimated glomerular filtration rate (SCr/eGFR) between the AKI and non-AKI groups, even in the first week post-transplant. In contrast, the post-transplant SCr/eGFR level of the AKI group recipients in adult cohorts did not recover to a level statistically similar to that of non-AKI recipients, even at 6-months post-transplant. Nonetheless, AKI kidney recipients were at an increased risk of DGF in both pediatric (34.1% vs. 16.8%) and adult (38.5% vs. 17.4%) cohorts. Conclusions: Kidney transplantation from deceased donors with AKI has short-term clinical outcomes comparable to those of non-AKI kidney transplantation. Pediatric AKI kidneys have a superior recovery of allograft function. The transplant community should utilize this donor pool to minimize waiting-list-related mortalities.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Liu

Zhang

Zhong

et al. 2022

Preprint

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“…A particular problem may be posed by donors with AKI. Despite a high incidence of DGF, graft survival may be obtained, although with inferior outcomes to those observed with standard donors [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. In the cases of successful kidney transplant from donors with AKI, it is possible that pretransplant, AKI was functional, being caused by the systemic and renal vasoconstriction related to the sympathetic overactivity and medications used to sustain circulation.…”

Section: Risk Factors For Dgfmentioning

confidence: 99%

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Ponticelli¹,

Reggiani

Moroni

2022

JPM

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Background. Delayed graft function is a frequent complication of kidney transplantation that requires dialysis in the first week posttransplant. Materials and Methods. We searched for the most relevant articles in the National Institutes of Health library of medicine, as well as in transplantation, pharmacologic, and nephrological journals. Results. The main factors that may influence the development of delayed graft function (DGF) are ischemia–reperfusion injury, the source and the quality of the donated kidney, and the clinical management of the recipient. The pathophysiology of ischemia–reperfusion injury is complex and involves kidney hypoxia related to the duration of warm and cold ischemia, as well as the harmful effects of blood reperfusion on tubular epithelial cells and endothelial cells. Ischemia–reperfusion injury is more frequent and severe in kidneys from deceased donors than in those from living donors. Of great importance is the quality and function of the donated kidney. Kidneys from living donors and those with normal function can provide better results. In the peri-operative management of the recipient, great attention should be paid to hemodynamic stability and blood pressure; nephrotoxic medicaments should be avoided. Over time, patients with DGF may present lower graft function and survival compared to transplant recipients without DGF. Maladaptation repair, mitochondrial dysfunction, and acute rejection may explain the worse long-term outcome in patients with DGF. Many different strategies meant to prevent DGF have been evaluated, but only prolonged perfusion of dopamine and hypothermic machine perfusion have proven to be of some benefit. Whenever possible, a preemptive transplant from living donor should be preferred.

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“…The presence of AKI in organ donors appears to impact the willingness to accept and transplant donor kidneys in China [ 25 ]. The incidence rate of AKI ranges from 25 to 52% within pediatric intensive care units [ 26 , 27 ], and to augment the donor pool with systematic analysis of kidney transplants from pediatric donors with AKI, we found that although the incidence of DGF was higher in recipients of allografts with AKI, deceased donor AKI status itself did not affect death-censored graft and recipient survival.…”

Section: Discussionmentioning

confidence: 99%

Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury

et al. 2023

View full text Add to dashboard Cite

Background The use of kidneys from deceased donors with acute kidney injury (AKI) to expand the donor pool is an ongoing trend. Prior research on the utilization of AKI donor kidneys, especially from pediatric AKI donors, was limited and has been subject to small sample sizes. In this study, we aimed to evaluate the safety and effectiveness of early post-transplantation outcomes in pediatric deceased donors with AKI. Methods This retrospective study compared the clinical results (including delayed graft function [DGF], acute rejection, patient and death-censored graft survival rates and renal function post-transplant) of kidney transplantation from deceased donors who were categorized as pediatric donors and adult donors with or without AKI, as defined by the Kidney Disease: Improving Global Outcomes (KIDGO) criteria, at our center between January 2018 and December 2020. Results Of the 740 patients, 154 received kidneys from pediatric donors (with AKI group [n = 41]; without AKI group [n = 113]), and 586 received kidneys from adult donors (with AKI group [n = 218]; without AKI group [n = 368]). The baseline characteristics were similar in both cohorts. No significant difference was observed in 1-year patient survival, death-censored graft survival, or acute rejection between the AKI and non-AKI groups in both the pediatric and adult cohorts. However, compared with those transplanted with adult AKI kidneys, those transplanted with pediatric AKI kidneys showed a superior recovery of allograft function. In pediatric cohorts, no significant difference was found in serum creatinine/estimated glomerular filtration rate (SCr/eGFR) between the AKI and non-AKI groups, even in the first week post-transplant. In contrast, the post-transplant SCr/eGFR level of the AKI group recipients in adult cohorts did not recover to a level statistically similar to that of non-AKI recipients, even at 6-months post-transplant. Nonetheless, AKI kidney recipients were at an increased risk of DGF in both pediatric (34.1% vs. 16.8%) and adult (38.5% vs. 17.4%) cohorts. Conclusions Kidney transplantation from deceased donors with AKI has short-term clinical outcomes comparable to those of non-AKI kidney transplantation. Pediatric AKI kidneys have a superior recovery of allograft function. The transplant community should utilize this donor pool to minimize waiting-list-related mortalities.

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Single kidney transplantation from donors with acute kidney injury: A single‐center experience

Cited by 11 publications

References 32 publications

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Excellent Clinical Outcomes of Renal Transplant from Pediatric Deceased Donors with Acute Kidney Injury

Delayed Graft Function in Kidney Transplant: Risk Factors, Consequences and Prevention Strategies

Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury

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