Excellent Intermediate-Term Results after Renal Transplantation from Brain-Dead Donors with Acute Kidney Injury

Abstract

Background: Organ shortage remains the leading obstacle in kidney transplantation. Whether organs from brain-dead donors with acute kidney injury (AKI) should be accepted for transplantation is still a matter of debate. Methods: Centre-based, matched cohort study of 33 renal transplant patients who had received a renal allograft by way of rescue allocation from a donor with AKI prior to organ procurement. 65 kidney transplants devoid of AKI in the donor and performed in each case directly beforehand and thereafter served as controls. Results: All donors with AKI were classified according to the RIFLE criteria: Of these, 3 donors (9.1%) fulfilled level “Risk”, 18 (54.6%) level “Injury”, and 12 (36.4%) level “Failure”. Mean serum-creatinine was 2.41±0.88 mg/dL at time of procurement and 1.06±0.32 mg/dL on admission, respectively. AKI donors had a lower 24hr urine production (3.6 L [IQR 1.2-4.1 L] vs. 4.1 L, [IQR 3.1-5.3 L], P=0.009), were many times exposed to noradrenaline (31/33 [93.9%] vs. 47/65 [72.3%], P=0.02) and/or adrenaline (5/33 [15.2%] vs. 1/65 [1.5%], P=0.02), and had more often undergone cardio-pulmonary resuscitation (11/33 [33.3%] vs. 7/65 [10.8%] P=0.01). Recipient and transplant characteristics, including age, gender, waiting-time, cold ischemia, and immunosuppressive therapy were very similar excepting a more favourable HLA-match in control patients (P=0.01). Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4%] vs. 18/65 [27.7%], P=0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14. One year graft survival was very similar comparing the groups (93.6% [95%CI 76.8%-98.4%] vs. 90.3% [95%CI 0.79.6%-95.5%], log rank P=0.58).Figure: [Trajectories of serum creatinine levels]Conclusions: Kidneys from donors with AKI can be transplanted with an excellent intermediate prognosis and should not be discarded.