Abstract
We investigated the impact of acute kidney injury (AKI) in elderly deceased-donors (DDs) vs. AKI in young DDs on post-transplant clinical outcomes. A total of 709 kidney transplant recipients (KTRs) from 602 DDs at four transplant centers were enrolled. KTRs were divided into young-DDKT and elderly-DDKT groups according to the age of DD of 60 years. Both groups were subdivided into non-AKI-KT and AKI-KT subgroups according to AKI in DDs. We investigated short-term and long-term clinical outcomes of non-AKI-DDKT and AKI-DDKT subgroups within young-DDKT and elderly-DDKT groups. The incidence of DGF in the AKI-DDKT subgroup was higher and the allograft function within 12 months after KT in the AKI-DDKT subgroup was lower than those in the non-AKI-DDKT subgroup in both young-DDKT and elderly-DDKT groups. Death-censored allograft survival rate was significantly lower in the AKI-elderly-DDKT subgroup than that in the non-AKI-elderly-DDKT subgroup, but it did not differ between AKI-young-DDKT and non-AKI-young-DDKT subgroup. In multivariable analysis, AKI-elderly-DDKT was an independent risk factor for allograft failure (hazard ratio: 2.648, 95% CI: 1.170–5.994, p = 0.019) and a significant interaction between AKI and old age in DDs on allograft failure was observed (p = 0.001). AKI in elderly DDs, but not in young DDs, can significantly affect long-term allograft outcomes of KTRs.
Highlights
We investigated the impact of acute kidney injury (AKI) in elderly deceased-donors (DDs) vs. AKI in young DDs on post-transplant clinical outcomes
It has been reported that the proportion of elderly brain death patients was higher than that of younger brain death patients and that kidney transplantation (KT) from elderly DDs could give survival benefit in comparison with those remaining on dialysis[8]
The mean age and the proportion of diabetes mellitus (DM) as primary renal disease were higher in the elderly-DDKT group than those in the young-DDKT group (63.6 ± 3.0 vs. 46.7 ± 8.5 years, p < 0.001; 27.0% vs. 18.9%, p = 0.054)
Summary
We investigated the impact of acute kidney injury (AKI) in elderly deceased-donors (DDs) vs. AKI in young DDs on post-transplant clinical outcomes. AKI in elderly DDs, but not in young DDs, can significantly affect long-term allograft outcomes of KTRs. With a tremendous increase in the number of patients with end-stage renal disease, donor shortage in kidney transplantation (KT) has become a worldwide crucial issue to solve[1,2,3]. This has not been fully investigated yet Based on these backgrounds, the aim of this study was to investigate whether the impact of AKI in elderly DDs on post-transplant clinical outcomes might differ from that of AKI in young-DDs. For this, short-term and long-term clinical outcomes of KT from DDs without AKI (non-AKI-DDKT subgroup) versus those for KT from DDs with AKI (AKI-DDKT subgroup) within young-DDKT and elderly-DDKT groups were compared. The interaction between AKI and old age in DDs on post-transplant allograft survival was investigated
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