Transplantation of Kidneys From Donors With Acute Kidney Injury: Friend or Foe?

Boffa, Catherine; Leemkolk, F van de; Curnow, Eleanor; Heide, Jaap Homan van der; Gilbert, James; Sharples, Edward; Ploeg, Rutger J.

doi:10.1111/ajt.13966

Cited by 95 publications

(168 citation statements)

References 27 publications

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“…Similar to other studies that have reported on transplanting kidneys from donors with AKI, our study found a high rate of delayed graft function with satisfactory long‐term graft function …”

Section: Discussionsupporting

confidence: 91%

“…However, a US Scientific Registry of Transplant Recipients Report found an association with higher graft loss in expanded criteria donor kidneys but not standard donor criteria kidneys when there was more severe AKI as evidenced by higher donor serum creatinine levels . A further large registry study from the UK found that AKI was associated with delayed graft function but also inferior graft function and a small reduction in graft survival at 1 year; more severe grades of AKI were associated with primary non‐function …”

Section: Discussionmentioning

confidence: 99%

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Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy

et al. 2019

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Background Kidney transplantation is the preferred treatment for end‐stage renal failure. Unfortunately, donor organ shortages prevent many individuals receiving a renal transplant and there is a need to increase the pool of appropriate donors. The presence of acute kidney injury (AKI) in deceased donors has traditionally been a relative contraindication to renal transplantation, even though renal recovery may be favorable in the absence of chronic renal disease. Methods We undertook an 8 years retrospective observational study of potential deceased organ donors with AKI requiring renal replacement therapy (RRT). We evaluated the rate of successful transplantation as well as short term and outcomes at a median of 19.5 (13.0–52.7) months after donation. Results Amongst 1058 consented potential organ donors, 39 patients had AKI requiring RRT, of which 19 became donors (13 not medically suitable, 7 did not proceed to donation). The median (interquartile range (IQR)) donor age was 41 (34–50) years and norepinephrine, epinephrine and vasopressin were given to 18, 14 and 9 donors, respectively. From the 38 donated kidneys 34 were transplanted. The median (IQR) age of recipients was 53 (42.8–58.5) years and they were dialysis free in a median (IQR) of 5.5 (2.3–10.8) days. Only minor abnormalities were found at 3 and 6 months renal biopsies, and two patients experienced graft failure in the first 12 months. Conclusion Amongst deceased donors with AKI receiving RRT and vasoactive medications outcomes of renal transplantation seems acceptable in the absence of pre‐existing renal failure and other donor co‐morbidity. Such patients may be an important additional source of kidney donation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy

et al. 2019

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“…Other studies have also reported similar results; Hall et al reported that the incidence of DGF increased with the AKI stage (34%, 52%, and 57% in the Risk, Injury, and Failure stages, respectively, P < 0.001) . In a retrospective analysis of the UK Transplant Registry comprising 11 649 donors with 10 years of follow‐up, the incidence of DGF increased with the AKI stage (OR: 1.33, 95% CI: 1.15‐1.54 for stage 1; OR: 1.67, 95% CI: 1.37‐2.03 for stage 2; OR: 2.98, 95% CI: 2.25‐3.96 for stage 3) . The author also reported statistically significant differences in 1‐, 3‐, and 5‐year graft survival between recipients who received kidneys from donors with and without AKI; however, the survival rate was only 2% lower and the absolute reduction in eGFR was only 1.6 mL/min/1.73 m 2 with AKI, which was uncertain to have clinical significance.…”

Section: Discussionmentioning

confidence: 52%

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

Jiang

Song

Liu

et al. 2019

Pediatric Transplantation

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Introduction Despite a severe shortage of organ supply, patients are reluctant to accept organs from deceased donors with AKI, let alone from pediatric AKI donors. Methods We assessed 70 patients who received kidneys from donors with AKI (10 with pediatric and 60 with adult donors) and 176 contemporaneous patients who received kidneys from non‐AKI donors (41 with pediatric and 135 with adult donors) between March 2012 and February 2017 for retrospectively evaluating the clinical outcomes. Results AKI was defined and staging by the RIFLE criteria and pediatric‐modified RIFLE criteria. Median age was 11.00 years IQR (4.50‐14.00 years), and median weight was 25.00 kg (IQR, 17.00‐45.00 kg) for all pediatric donors. Median follow‐up was 8 months (range, 1‐49 months). Adult AKI group had the highest incidence of DGF (35.0% vs 10%, 9.8%, and 19.3%, P = 0.011). There was a significant increase in DGF in higher AKI stages (Risk: 20.7%, Injury: 46.7%, Failure: 50.0%; P = 0.014) among patients with adult donors. No significant differences were noted in 1‐year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) and 3‐year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) patient survival, and 1‐year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) and 3‐year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) graft survival. Conclusion Transplants procured from donors with AKI, particularly pediatric ones, could achieve excellent intermediate‐term clinical outcomes and thus potentially expand the donor pool.

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“…Multiple single‐center studies have demonstrated that kidneys transplanted from donors with AKI, typically defined as a terminal creatinine ≥2.0 mg/dl, have an increased risk of delayed graft function (DGF), with greater risk of DGF seen with more severe AKI . Despite the increased risk of early complications, these kidneys are associated with excellent allograft survival and allograft function in the short term, even with increasing severity of AKI in the donor [.] However, the majority of kidney transplants included in these studies had cold ischemia time (CIT) <24 h.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of kidney transplant from deceased donors with acute kidney injury and prolonged cold ischemia time - a retrospective cohort study

et al. 2019

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Summary While deceased donor renal transplants (DDRT) from donors with either acute kidney injury (AKI) or long cold ischemia time (CIT) are associated with increased risk of delayed graft function (DGF), recipients of these kidneys have good patient and allograft survival. There are limited data on whether kidneys with both AKI and long CIT have outcomes similar to kidneys with only one of these insults. Using data from the Scientific Registry of Transplant Recipients, we analyzed transplant outcomes in patients (2005–2015) receiving kidneys with AKI (terminal creatinine ≥2.0 mg/dl) and CIT 24–30 h (n = 1289), 30–36 h (n = 734), and >36 h (n = 614), using kidneys with AKI and CIT <24 h (n = 5434) as a reference. DGF was more common with increasing CIT up to 36 h, then decreased slightly (41.2% vs. 46.8% vs. 52.5% vs. 50.2%, P < 0.001). Death‐censored graft survival (DCGS) at 3 years was better with CIT <24 h compared with other groups (92.5% vs. 90.8% vs. 92% vs. 89.2%, P = 0.018). On multivariable analysis, donor creatinine was predictive of DCGS, whereas only CIT >36 h was predictive of DCGS (aHR 1.27, P = 0.03). Recipients transplanted with kidneys with both AKI and long CIT have excellent intermediate‐term outcomes.

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Transplantation of Kidneys From Donors With Acute Kidney Injury: Friend or Foe?

Cited by 95 publications

References 27 publications

Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy

Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy

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

Outcomes of kidney transplant from deceased donors with acute kidney injury and prolonged cold ischemia time - a retrospective cohort study

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