TY - JOUR
T1 - Deceased-donor acute kidney injury is not associated with kidney allograft failure
AU - Hall, Isaac E.
AU - Akalin, Enver
AU - Bromberg, Jonathan S.
AU - Doshi, Mona D.
AU - Greene, Tom
AU - Harhay, Meera N.
AU - Jia, Yaqi
AU - Mansour, Sherry G.
AU - Mohan, Sumit
AU - Muthukumar, Thangamani
AU - Reese, Peter P.
AU - Schröppel, Bernd
AU - Singh, Pooja
AU - Thiessen-Philbrook, Heather R.
AU - Weng, Francis L.
AU - Parikh, Chirag R.
N1 - Publisher Copyright:
© 2018 International Society of Nephrology
PY - 2019/1
Y1 - 2019/1
N2 - Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function. We also evaluated the association between donor AKI and a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73 m 2 in a subcohort of 30% of recipients. Among 2,430 kidneys transplanted from 1,298 deceased donors, 585 (24%) were from donors with AKI. Over a median follow-up of 4.0 years, there were no significant differences in graft survival by donor AKI stage. We found no evidence that pre-specified variables modified the effect of donor AKI on graft survival. In the subcohort, donor AKI was not associated with the 3-year composite outcome. Donor AKI was not associated with graft failure in this well-phenotyped cohort. Given the organ shortage, the transplant community should consider measures to increase utilization of kidneys from deceased donors with AKI.
AB - Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function. We also evaluated the association between donor AKI and a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73 m 2 in a subcohort of 30% of recipients. Among 2,430 kidneys transplanted from 1,298 deceased donors, 585 (24%) were from donors with AKI. Over a median follow-up of 4.0 years, there were no significant differences in graft survival by donor AKI stage. We found no evidence that pre-specified variables modified the effect of donor AKI on graft survival. In the subcohort, donor AKI was not associated with the 3-year composite outcome. Donor AKI was not associated with graft failure in this well-phenotyped cohort. Given the organ shortage, the transplant community should consider measures to increase utilization of kidneys from deceased donors with AKI.
KW - acute kidney injury
KW - chronic allograft nephropathy
KW - delayed graft function
UR - http://www.scopus.com/inward/record.url?scp=85059501587&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059501587&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2018.08.047
DO - 10.1016/j.kint.2018.08.047
M3 - Article
C2 - 30470437
AN - SCOPUS:85059501587
SN - 0085-2538
VL - 95
SP - 199
EP - 209
JO - Kidney international
JF - Kidney international
IS - 1
ER -