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Am J Transplant. 2015 Jun;15(6):1623-31. doi: 10.1111/ajt.13144. Epub 2015 Mar 11.

Associations of deceased donor kidney injury with kidney discard and function after transplantation.

Author information

1
Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT.
2
Section of Nephrology, Yale University School of Medicine, New Haven, CT.
3
Section of Nephrology, Department of Internal Medicine 1, University Hospital, Ulm, Germany.
4
Wayne State University, Detroit, MI.
5
Barnabas Health, Livingston, NJ.
6
Gift of Life Institute, Philadelphia, PA.
7
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
8
University of Pennsylvania, Philadelphia, PA.
9
Veterans Affairs Connecticut Healthcare System, New Haven, CT.

Abstract

Deceased donor kidneys with acute kidney injury (AKI) are often discarded due to fear of poor outcomes. We performed a multicenter study to determine associations of AKI (increasing admission-to-terminal serum creatinine by AKI Network stages) with kidney discard, delayed graft function (DGF) and 6-month estimated glomerular filtration rate (eGFR). In 1632 donors, kidney discard risk increased for AKI stages 1, 2 and 3 (compared to no AKI) with adjusted relative risks of 1.28 (1.08-1.52), 1.82 (1.45-2.30) and 2.74 (2.0-3.75), respectively. Adjusted relative risk for DGF also increased by donor AKI stage: 1.27 (1.09-1.49), 1.70 (1.37-2.12) and 2.25 (1.74-2.91), respectively. Six-month eGFR, however, was similar across AKI categories but was lower for recipients with DGF (48 [interquartile range: 31-61] vs. 58 [45-75] ml/min/1.73m(2) for no DGF, p < 0.001). There was significant favorable interaction between donor AKI and DGF such that 6-month eGFR was progressively better for DGF kidneys with increasing donor AKI (46 [29-60], 49 [32-64], 52 [36-59] and 58 [39-71] ml/min/1.73m(2) for no AKI, stage 1, 2 and 3, respectively; interaction p = 0.05). Donor AKI is associated with kidney discard and DGF, but given acceptable 6-month allograft function, clinicians should consider cautious expansion into this donor pool.

KEYWORDS:

deceased; delayed graft function (DGF); donors and donation; kidney failure/injury; organ acceptance

PMID:
25762442
PMCID:
PMC4563988
DOI:
10.1111/ajt.13144
[Indexed for MEDLINE]
Free PMC Article
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