Excellent Outcome Following Transplantation Using Kidneys From Deceased Donors With Severe Acute Kidney Injury (AKI).

Abstract

Background: Our aim was to determine the outcomes following transplant with kidneys from standard criteria donors (SCD) with severe AKI. Methods: We included all SCD kidney transplant recipients at our center from 7/2004 to 10/2013. AKI donor was defined as a donor terminal creatinine (Cr) > 2.0. The acute kidney injury network criteria (AKIN) were used to stage the severity of the AKI in the donors (stage 3 requiring Cr 3 times baseline elevation or increase Cr ≥ 4 or urine output < 0.3 ml/kg for > 24 hours or anuria > 12 hours). Criteria for accepting AKI donor kidneys were: no cortical necrosis or significant chronic changes on pre-implantation biopsy and acceptable pump parameters (flow>80 and RI<0.40). Results: There were 611 SCD kidneys transplanted during this period: 139 in the AKI group and 472 in the non-AKI group. Baseline recipient characteristics were similar. The AKI group had longer cold ischemia time (20.4±8.0 vs. 15.9±7.3, p<0.0001) and were more likely to be male donors (78% vs. 61%, p=0.0001). HLA mismatch was higher in the AKI group (3.9±1.6 vs. 3.5±2.0, p=0.03). Characteristics of the AKI donor group: peak Cr 4.66±2.39, terminal Cr 4.09±2.20, oligo-anuric in 50%, renal replacement therapy in 21%. DGF was more common in the AKI group, but GFR and biopsy changes at 1 yr, and graft survival were similar, including for the AKIN stage 3 Group.Table: No Caption available.Figure: No Caption available.Conclusion: Graft survival, eGFR and biopsy findings at 1 year for select AKI SCD kidneys, including AKIN stage 3, are similar to recipients of non AKI SCD kidneys. Long term follow up is needed to further validate these findings.