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

I. E. Hall, B. Schröppel, M. D. Doshi, J. Ficek, F. L. Weng, R. D. Hasz, H. Thiessen-Philbrook, P. P. Reese, C. R. Parikh

Research output: Contribution to journalArticlepeer-review

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/1.73m2 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/1.73m2 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.

Original languageEnglish (US)
Pages (from-to)1623-1631
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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