Transplantation With Kidneys Retrieved From Deceased Donors With Acute Renal Failure

Klein, Rodrigo Moreno; Galante, Nelson Zocoler; Sandes‐Freitas, Tainá Veras de; Franco, Marcello; Tedesco‐Silva, Hélio; Medina-Pestana, J.O.

doi:10.1097/tp.0b013e318279153c

Cited by 64 publications

(94 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The presence of AKI in the donor had no effect on the 1-year patient and graft survival, on the rate of acute rejections and on creatinine clearance within the first year. This finding applied to renal transplant recipients from extended criteria donors (n = 137 without AKI, n = 116 with AKI) and to recipients from standard criteria donors (n = 896 without AKI, n = 369 with AKI) [13]. Since these data were obtained from the USA and Brazil with DBDs of a comparably low mean age, they may not be transferable to Europe and/or considerably higher donor ages.…”

Section: Introductionmentioning

confidence: 92%

“…Unexpectedly, the well-known adverse effect of delayed graft function (DGF) on graft survival could not be seen in recipients of AKI kidneys, but was evident in recipients of standard donor kidneys [12,18]. Klein et al [13] reported their extensive center experience in a study of 1518 renal transplant recipients between 1998 and 2008, including 485 transplants from a DBD with AKI (defined by a donor serum creatinine concentration >1.5 mg/dL). The presence of AKI in the donor had no effect on the 1-year patient and graft survival, on the rate of acute rejections and on creatinine clearance within the first year.…”

Section: Introductionmentioning

confidence: 97%

“…However, in the last 10 years, case reports and large case series have been published and clinical practice has been changing, i.e., AKI kidneys from wellselected DBDs can successfully be used for transplantation [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Specifically, two recent large studies deserve to be highlighted.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

et al. 2015

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Demographic characteristics know to be associated with real function at 12 months may also account for this observation. For example, the incidence of DGF among deceased donor kidney transplant recipients is relatively high, ranging from 45 to 53%, despite no differences being present among the groups [15]. In the r-ATG/EVR group, the mean final creatinine of deceased donors was higher compared to the other 2 groups.…”

Section: Discussionmentioning

confidence: 99%

Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus

et al. 2017

View full text Add to dashboard Cite

Background: This analysis compared efficacy, renal function, and histology in kidney transplant recipients receiving tacrolimus (TAC) combined with everolimus (EVR) or mycophenolate (MPS). Methods: This was a retrospective analysis from a randomized trial in kidney transplant recipients who received a single 3 mg/kg dose of rabbit antithymocyte globulin (r-ATG), TAC, EVR, and prednisone (PRED; r-ATG/EVR, n = 85), basiliximab (BAS), TAC, EVR, and PRED (BAS/EVR, n = 102) or BAS, TAC, MPS, and PRED (BAS/MPS, n = 101). We evaluated the incidence of de novo donor-specific anti-human leukocyte antigens antibodies (DSA) and histology on protocol biopsies at 12 months, and the incidence of acute rejection, estimated glomerular filtration rate (eGFR) and proteinuria at 36 months. Results: At 12 months, there were no differences in de novo DSA (6.4 vs. 3.4 vs. 5.5%) or in subclinical inflammation (2.0 vs. 4.8 vs. 10.2%), interstitial fibrosis/tubular atrophy (57.1 vs. 58.5 vs. 53.8%) and C4d deposition (2.0 vs. 7.3 vs. 2.6%). At 36 months, there were no differences in the incidence of treatment failure (19.0 vs. 27.7 vs. 27.7%, p = 0.186), first biopsy-proven acute rejection (9.5 vs. 21.8 vs. 16.8%, p = 0.073), and urine protein/creatinine ratios (0.53 ± 1.05 vs. 0.62 ± 0.75 vs. 0.71 ± 1.24). eGFR was lower in the BAS/EVR compared to that in the BAS/MPS group (53.4 ± 20.9 vs. 50.8 ± 19.5 vs. 60.7 ± 21.2 mL/min/1.73 m², p = 0.017) but comparable using a sensitive analysis (49.5 ± 23 vs. 47.5 ± 22.6 vs. 53.6 ± 27.8 mL/min/1.73 m², p = 0.207). Conclusion: In this cohort, the use of EVR and reduced TAC concentrations were associated with comparable efficacy, renal function, and histological parameters compared to the standard-of-care immunosuppressive regimen.

show abstract

“…Several factors directly or indirectly related to AKI have been evaluated in transplantation, including preservation technique, cold-ischemia time, and donor terminal creatinine (10), although many authors argue against discarding kidneys based on high creatinine levels alone (2,(11)(12)(13). Little attention, however, has been given to assessing the degree of structural AKI in the donor apart from conventional "proxy" measures such as cold-ischemia time or creatinine.…”

Section: Introductionmentioning

confidence: 99%

Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes

Hall

Reese

Weng³

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives The influence of deceased-donor AKI on post-transplant outcomes is poorly understood. The few published studies about deceased-donor preimplant biopsy have reported conflicting results regarding associations between AKI and recipient outcomes.Design, setting, participants, & measurements This multicenter study aimed to evaluate associations between deceased-donor biopsy reports of acute tubular necrosis (ATN) and delayed graft function (DGF), and secondarily for death-censored graft failure, first adjusting for the kidney donor risk index and then stratifying by donation after cardiac death (DCD) status.Results Between March 2010 and April 2012, 651 kidneys (369 donors, 4 organ procurement organizations) were biopsied and subsequently transplanted, with ATN reported in 110 (17%). There were 262 recipients (40%) who experienced DGF and 38 (6%) who experienced graft failure. DGF occurred in 45% of kidneys with reported ATN compared with 39% without ATN (P=0.31) resulting in a relative risk (RR) of 1.13 (95% confidence interval [95% CI], 0.9 to 1.43) and a kidney donor risk index-adjusted RR of 1.11 (95% CI, 0.88 to 1.41). There was no significant difference in graft failure for kidneys with versus without ATN (8% versus 5%). In stratified analyses, the adjusted RR for DGF with ATN was 0.97 (95% CI, 0.7 to 1.34) for non-DCD kidneys and 1.59 (95% CI, 1.23 to 2.06) for DCD kidneys (P=0.02 for the interaction between ATN and DCD on the development of DGF).Conclusions Despite a modest association with DGF for DCD kidneys, this study reveals no significant associations overall between preimplant biopsy-reported ATN and the outcomes of DGF or graft failure. The potential benefit of more rigorous ATN reporting is unclear, but these findings provide little evidence to suggest that current ATN reports are useful for predicting graft outcomes or deciding to accept or reject allograft offers.

show abstract

Transplantation With Kidneys Retrieved From Deceased Donors With Acute Renal Failure

Abstract: In this cohort of patients, kidneys from deceased donors with ARF provided graft survival and renal function comparable with kidneys from donors without ARF 1 year after transplantation.

Cited by 64 publications

References 20 publications

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

Donor-Specific Anti-Human Leukocyte Antigens Antibodies, Acute Rejection, Renal Function, and Histology in Kidney Transplant Recipients Receiving Tacrolimus and Everolimus

Preimplant Histologic Acute Tubular Necrosis and Allograft Outcomes

Contact Info

Product

Resources

About