Transplantation of Kidneys From Donors With Acute Kidney Injury

Boffa, Catherine; Leemkolk, F van de; Curnow, Elinor; Gilbert, James; Sharples, Edward; Ploeg, Rutger J.

doi:10.1097/01.tp.0000525118.26374.d8

Cited by 4 publications

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“…Nevertheless, the acceptance of organs from donors with AKI remains a controversial issue. This point is substantiated by existing studies describing lower rates of kidney function and survival after transplantation of organs from donors with AKI [15,22] despite the very limited quantitative disadvantage with respect to kidney function and survival of organs from donors with AKI reported by Boffa et al [15]. Interestingly, Kolonko et al described an impaired long-term functionality of kidneys from donors with AKI and an increased risk of transplant loss in an AKI group.…”

Section: Discussionmentioning

confidence: 79%

“…In that study, the mean recipient and donor age was 37 years and the rate of ECD-type kidneys was 12.9%; thus, these results cannot be compared with those obtained in Germany. Interestingly, according to a retrospective analysis of the United Kingdom Transplant Registry published by Boffa et al [15], among 11219 kidney transplantations investigated, 1869 organs were from donors with AKI. Transplant survival after 1 year was only 2% higher than that of organs from donors with AKI (91% vs. 89%).…”

Section: Discussionmentioning

confidence: 99%

“…In both reports, however, no correlation was found between PNF and the nature of AKI in the donor. The study by Boffa et al, on the other hand, reported that AKI, particularly AKIN stage 3 or higher, affected the occurrence of PNF [15].…”

Section: Discussionmentioning

confidence: 99%

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Success of kidney transplantations from deceased donors with acute kidney injury

et al. 2018

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BackgroundThe acceptance of organs from deceased donors with acute kidney injury (AKI) varies considerably, with uncertain outcomes. The current organ shortage has led to increased use of marginal donor organs.Material/MethodsThis retrospective, single-center study included 642 patients who underwent kidney allograft transplantation between 2005 and 2016. The recipients were categorized into 3 groups: AKI-1 (n=214), comprising donors with a peak serum creatinine (SCr) level of 1.1–2.0 mg/dl; AKI-2 (n=89), comprising donors with a peak SCr level >2 mg/dl; and non-AKI (n=339), comprising donors with normal kidney function (SCr <1.1 mg/dl).ResultsThe cumulative survival rates for patients and grafts did not significantly differ among the AKI-1, AKI-2, and non-AKI groups at the 1-year (91.6%/79.4%, 92.1%/83.1%, 95.3%/88.5%, respectively) and 5-year assessments (79.4%/67.8%, 86.8%/71.7%, 80.5%/71.1%, respectively). These findings were corroborated by mean SCr values and estimated glomerular filtration rates at the 1-year (2.08±1.7/51.16±23.45, 2.01±1.52/56.46±23.63, 1.81±1.13/ 55.44±23.26 mg/dl, respectively) and 5-year assessments (1.91±1.28/51.06±24.65, 1.74±0.66/57.44±31.21, 1.7±0.88/ 58.56±26.04 mg/dl, respectively). The incidence of delayed graft function in each group was 29.9%, 44.9%, and 28.6%, respectively.ConclusionsKidney transplantation from donors with AKI, although associated with a higher rate of delayed graft function, results in good long-term transplant survival and reliable kidney functionality after 5 years. The inclusion of donors with AKI may widely extend the pool of available organs; however, careful donor selection is necessary.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Success of kidney transplantations from deceased donors with acute kidney injury

et al. 2018

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“…5,6,27,28 A study from the UK demonstrated slightly poorer kidney function after 1 year among recipients of kidneys from donors with stage 3 AKI compared with those without AKI. 10 However, the overall acceptance rate of kidneys was higher in the UK (90%) than in the US (75%), 6,10 suggesting that further research is needed to identify the small subgroup of donors with suboptimal kidney repair capacity.…”

Section: Discussionmentioning

confidence: 99%

“…9 However, up to 44% of these kidneys are not transplanted due to concerns that kidneys from these donors may lead to more intense acute tubular injury that is less likely to recover and more likely have inferior longer-term graft outcomes. 10 Furthermore, prior studies rarely included deceased donors who had the most severe AKI stage and who received dialysis before kidney donation. 11 Therefore, recipient outcomes after kidney transplant from these donors are not well described.…”

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confidence: 99%

Kidney Transplant Outcomes From Deceased Donors Who Received Dialysis

Wen,

Mansour,

Srialluri

et al. 2024

JAMA

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ImportanceRecipient outcomes after kidney transplant from deceased donors who received dialysis prior to kidney donation are not well described.ObjectiveTo compare outcomes of transplant recipients who received kidneys from deceased donors who underwent dialysis prior to kidney donation vs recipients of kidneys from deceased donors who did not undergo dialysis.Design, Setting, and ParticipantsA retrospective cohort study was conducted including data from 58 US organ procurement organizations on deceased kidney donors and kidney transplant recipients. From 2010 to 2018, 805 donors who underwent dialysis prior to kidney donation were identified. The donors who underwent dialysis prior to kidney donation were matched 1:1 with donors who did not undergo dialysis using a rank-based distance matrix algorithm; 1944 kidney transplant recipients were evaluated.ExposureKidney transplants from deceased donors who underwent dialysis prior to kidney donation compared with kidney transplants from deceased donors who did not undergo dialysis.Main Outcomes and MeasuresThe 4 study outcomes were delayed graft function (defined as receipt of dialysis by the kidney recipient ≤1 week after transplant), all-cause graft failure, death-censored graft failure, and death.ResultsFrom 2010 to 2018, 1.4% of deceased kidney donors (805 of 58 155) underwent dialysis prior to kidney donation. Of these 805 individuals, 523 (65%) donated at least 1 kidney. A total of 969 kidneys (60%) were transplanted and 641 kidneys (40%) were discarded. Among the donors with kidneys transplanted, 514 (mean age, 33 years [SD, 10.8 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) underwent dialysis prior to donation and were matched with 514 (mean age, 33 years [SD, 10.9 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) who did not undergo dialysis. Kidney transplants from donors who received dialysis prior to donation (n = 954 kidney recipients) were associated with a higher risk of delayed graft function compared with kidney transplants from donors who did not receive dialysis (n = 990 kidney recipients) (59.2% vs 24.6%, respectively; adjusted odds ratio, 4.17 [95% CI, 3.28-5.29]). The incidence rates did not significantly differ at a median follow-up of 34.1 months for all-cause graft failure (43.1 kidney transplants per 1000 person-years from donors who received dialysis prior to donation vs 46.9 kidney transplants per 1000 person-years from donors who did not receive dialysis; adjusted hazard ratio [HR], 0.90 [95% CI, 0.70-1.15]), for death-censored graft failure (22.5 vs 20.6 per 1000 person-years, respectively; adjusted HR, 1.18 [95% CI, 0.83-1.69]), or for death (24.6 vs 30.8 per 1000 person-years; adjusted HR, 0.76 [95% CI, 0.55-1.04]).Conclusions and RelevanceCompared with receiving a kidney from a deceased donor who did not undergo dialysis, receiving a kidney from a deceased donor who underwent dialysis prior to kidney donation was associated with a significantly higher incidence of delayed graft function, but no significant difference in graft failure or death at follow-up.

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