Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries

Wiwattanathum, Punlop; Ingsathit, Atiporn; Kantachuvesiri, Surasak; Arpornsujaritkun, Nuttapon; Tirapanich, Wiwat; Sumethkul, V.

doi:10.5500/wjt.v6.i4.712

Cited by 7 publications

(5 citation statements)

References 12 publications

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“…Our preliminary 1-year results were in agreement with other reports and were subsequently confirmed by two smaller studies. 21,22 Our current results with complete follow-up beyond the first year are consistent with the U.K. kidney transplant report by Boffa et al regarding long-term outcomes. 23 While the Standard Transplant Analysis and Research file from the Organ Procurement and Transplantation Network (OPTN) does not provide serial serum creatinines, the U.K.…”

Section: Discussionsupporting

confidence: 91%

Deceased-donor acute kidney injury is not associated with kidney allograft failure

Hall

Akalin

Bromberg

et al. 2019

Kidney International

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Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function. We also evaluated the association between donor AKI and a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73m2 in a subcohort of 30% of recipients. Among 2,430 kidneys transplanted from 1,298 deceased donors, 585 (24%) were from donors with AKI. Over a median follow-up of 3.7 years, there were no significant differences in graft survival by donor AKI stage. We found no evidence that pre-specified variables modified the effect of donor AKI on graft survival. In the subcohort, donor AKI was not associated with the 3-year composite outcome. Donor AKI was not associated with graft failure in this well-phenotyped cohort. Given the organ shortage, the transplant community should consider measures to increase utilization of kidneys from deceased donors with AKI.

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Section: Discussionsupporting

confidence: 91%

Deceased-donor acute kidney injury is not associated with kidney allograft failure

Hall

Akalin

Bromberg

et al. 2019

Kidney International

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“…Data from 17 studies [ 14 , 20 – 22 , 24 , 29 – 33 , 35 , 37 , 38 , 40 , 41 , 44 , 46 ] reporting acute rejection was pooled. The results show no significant difference in the odds of acute rejection between donor AKI vs. non-AKI kidneys groups (OR 1.29, 95% CI = 0.97–1.71, I 2 = 76%, Z = 1.75, p = 0.08).…”

Section: Resultsmentioning

confidence: 99%

“…14 studies [ 14 , 19 – 22 , 28 – 30 , 35 , 37 , 39 , 43 – 45 ] reported the eGFR at 12 or more months post-renal transplantation. The pooled results show similar eGFR levels between the AKI and non-AKI populations (WMD = −2.09, 95% CI = −3.56 to 0.62, I 2 = 41%, Z = 2.79, p = 0.05) ( Figure 6 ).…”

Section: Resultsmentioning

confidence: 99%

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Kidney Transplantation From Donors With Acute Kidney Injury: Are the Concerns Justified? A Systematic Review and Meta-Analysis

Nita¹,

Gopal²,

Khambalia³

et al. 2023

Transpl Int

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Renal transplantation improves quality of life and prolongs survival in patients with end-stage kidney disease, although challenges exist due to the paucity of suitable donor organs. This has been addressed by expanding the donor pool to include AKI kidneys. We aimed to establish whether transplanting such kidneys had a detrimental effect on graft outcome. The primary aim was to define early outcomes: delayed graft function (DGF) and primary non-function (PNF). The secondary aims were to define the relationship to acute rejection, allograft survival, eGFR and length of hospital stay (LOS). A systematic literature review and meta-analysis was conducted on the studies reporting the above outcomes from PubMed, Embase, and Cochrane Library databases. This analysis included 30 studies. There is a higher risk of DGF in the AKI group (OR = 2.20, p < 0.00001). There is no difference in the risk for PNF (OR 0.99, p = 0.98), acute rejection (OR 1.29, p = 0.08), eGFR decline (p = 0.05) and prolonged LOS (p = 0.11). The odds of allograft survival are similar (OR 0.95, p = 0.54). Transplanting kidneys from donors with AKI can lead to satisfactory outcomes. This is an underutilised resource which can address organ demand.

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“…Of the 1428 citations identified from the electronic and hand searches, 123 full-text articles were identified for possible eligibility, and after exclusion, 33 single-center studies, 8 , 12 , 27 – 57 four multicenter studies, 5 , 58 – 60 and seven registry-based studies 7 , 11 , 13 , 61 – 64 were included in the meta-analysis (Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

Short-Term, Mid-Term, and Long-Term Outcomes after Deceased Donor Kidney Transplantation in Patients with AKI

Scurt,

Hammoud,

Bose

et al. 2024

Kidney360

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Background Acute kidney injury (AKI) is a common complication in hospitalized patients and may occur in potential kidney donors. Observational studies have suggested that kidney transplantation in patients with AKI is feasible and safe, but no systematic evaluation has been performed. Methods We performed a systematic review and meta-analysis to evaluate the outcomes of kidney transplantation in patients with AKI. We searched MEDLINE, EMBASE, Cochrane, Google Scholar, and other databases for studies reporting outcomes of donor kidneys with AKI. We included single-center, multicenter, and registry-based studies and analyzed them according to the definition and severity of AKI. Endpoints were primary and delayed graft function (PNF, DGF), length of hospital stay, rejection, graft function, patient and graft survival at one, three, five, and eight to ten years after transplantation. This study was registered in PROSPERO, number CRD42021260088. Results We identified 33 single-center, 4 multicenter, and 7 registry studies with more than 100,000 patients published between 2005 and 2022. Recipients from donors with AKI had a higher risk of delayed graft function (RR 1.51, 95% CI 1.35-1.68). Graft function at discharge was worse in the AKI group (MDCrea (95%CI): 0.96 mg/dl (0.36-1.56 I2=96%), MDGFR (95%CI): -8.88 ml/min1.73 m2 (-15.32 - -2.44 I2=93%)), but improved thereafter and was similar in both groups at 3 months after transplantation (MDCrea (95%CI): -0.05 mg/dl (-0.18-0.07 I2=0%), MDGFR (95%CI): -1.83 ml/min1.73 m2 (-5.29 - 1.63 I2=91%)). PNF and patient and graft survival were simila at one, three, five, and eight to ten years after transplantation. There were no differences in rejections regardless of AKI definition and severity. Conclusion Transplantation of kidneys with AKI is associated with satisfactory short- and long-term outcomes and should be pursued to increase the donor pool.

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Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries

Cited by 7 publications

References 12 publications

Deceased-donor acute kidney injury is not associated with kidney allograft failure

Deceased-donor acute kidney injury is not associated with kidney allograft failure

Kidney Transplantation From Donors With Acute Kidney Injury: Are the Concerns Justified? A Systematic Review and Meta-Analysis

Short-Term, Mid-Term, and Long-Term Outcomes after Deceased Donor Kidney Transplantation in Patients with AKI

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