Transplant outcomes using kidneys from high KDPI acute kidney injury donors

Abstract

Kidney transplant (KT) outcomes from high kidney donor profile index (KDPI ≥85%) donors with acute kidney injury (AKI) remain underreported. KT from 172 high KDPI Acute Kidney Injury Network (AKIN) stage 0‐1 donors and 76 high KDPI AKIN stage 2‐3 donors from a single center were retrospectively assessed. The AKIN 2‐3 cohort had more delayed graft function (71% vs. 37%, p < .001). At one year, there were no differences in the estimated glomerular filtration rate (44 ± 17 vs. 46 ± 18, p = .42) or fibrosis on protocol biopsy (ci, p = .85). Donor terminal creatinine (p = .59) and length of delayed graft function (p = .39) did not impact one‐year eGFR. There were more primary nonfunction (PNF) events in the high KDPI AKIN 2‐3 group (5.3% vs. 0.6%, p = .02). With a median follow‐up of 3.8 years, one‐year death‐censored graft failure was 3.5% for AKIN 0‐1 and 14.5% for AKIN 2‐3 (HR 2.40, 95% CI 1.24‐4.63, p = .01). Although AKIN stage 2‐3 high KDPI kidneys had comparable one‐year eGFR to AKIN stage 0‐1 high KDPI kidneys, there were more PNF occurrences and one‐year death‐censored graft survival was reduced. Given these findings, additional precautions should be undertaken when assessing and utilizing kidneys from severe AKI high KDPI donors.

Successful outcomes with transplanting kidneys from deceased donors with acute kidney injuryon temporary renal replacement therapy

“…Previously, we reported that severe AKI donors with high KDPI (surrogate for age) are at higher risk for PNF. 16 In high KDPI the overall incidence of PNF was higher in the AKIN 2-3 group compared to AKIN 0-1 (5.3% vs. 0.6%, p = .02). 16 PNF in the study was related to high KDPI and chronic changes that were missed on preimplantation biopsy.…”

“…PNF rates here are similar to what we have previously reported 4 and were related to high KDPI kidney. Previously, we reported that severe AKI donors with high KDPI (surrogate for age) are at higher risk for PNF 16 . In high KDPI the overall incidence of PNF was higher in the AKIN 2–3 group compared to AKIN 0–1 (5.3% vs. 0.6%, p = .02) 16 .…”

“…We also examined high KDPI ≥ 85% AKIN0 group and provided the results in supplement (S1). Acute kidney injury was classified per creatinine change as noted in the AKIN classification system and as we have previously reported 2,15–17 . Acute Kidney Injury Network 3 was defined as an increase in serum creatinine by 3 times over baseline or creatinine > 4 mg/dL with an acute rise by at least 0.5 mg/dL or the initiation of RRT 17 …”

“…We have previously included AKIN stage 3 donors on RRT in our prior studies but not as a separate group. 2,4,15,16 Other recent reports describing outcomes of kidneys from AKIN 3 donors do not mention RRT, and to date, there has not been a dedicated analysis specifically looking at outcomes of AKIN 3 donors on RRT. 7,15 In the present study, we report the outcomes of a large cohort of kidney transplants performed at a single center utilizing kidneys from donors with severe AKI (AKIN stage 3) on temporary RRT compared to AKIN3 donors not on RRT, and KDPI < 85% donors without AKI (AKIN0).…”

Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation

“…Despite these limitations, we feel that our experience with DGF and outcomes are valuable. Despite using donors with higher risk features and overall higher rates of DGF, we have reported excellent outcomes [ 8 , 9 , 16 , 19 , 20 ]. Moreover, this current study provides granular details specific to DGF that are not available from larger database studies.…”