Baseline Biopsy Findings and Clinical Outcomes in Recipients of Kidneys from Standard Criteria Donors (SCD) with Acute Kidney Injury (AKI)

Abstract

Background: Kidneys from deceased donors with AKI remain an underutlized source for transplantation. Biopsy findings and medium to long-term outcome in this group is not well described. Methods: Retrospective chart review of 398 SCD Txs done at our center including 50 with AKI (terminal creatinine >2.0 or requiring renal replacement therapy). Baseline biopsy findings and clinical outcomes in AKI group were compared to those without AKI. Results: The mean age of the AKI donors was 33 16 yrs, 74% male and trauma was the cause of death in 26%. Mean admission, peak and terminal creatinine values in the AKI group were 1.6, 3.9, and 3.4, respectively. 38% were oliguric/anuric and 10% were on renal replacement therapy. The recipient characteristics were similar except that the mean HLA mismatch and % with DSA were higher in the AKI group (8% vs 19% p=0.07). AKI group has more imported kidneys (52% vs 29% p=0.002), had longer cold ischemia time (18.0 8.1 vs 15.5 7.1, p=0.02), and more likely to be placed on mechanical pulsatile perfusion. Post reperfusion biopsy findings showed ATN grade 2-4 in 50% in AKI vs 27% in the control group (p=0.0005). Golmerular thrombi were seen in 13% and 5% in the AKI and control groups respectively (p=0.27). Other biopsy findings were similar between the two groups. Clinical outcomes and death censored graft survival are shown below:Figure: [outcomes and graft survival]The outcomes in the subgroup with oliguria/anuria or renal replacement therapy were no different than the rest of the AKI group. Conclusions: AKI donor kidneys have similar findings on baseline biopsy compared to those without AKI except higher degree of ATN. The graft survival and graft function in the AKI group are excellent and similar to those without AKI. There is an opportunity to expand the use of AKI kidneys for transplantation including those with oliguria/anuria or renal replacement therapy.