Abstract
BackgroundFavorable long-term and short-term graft survival and patient survival after kidney transplantation (KT) from deceased donors with acute kidney injury (AKI) have been reported. However, few studies have evaluated effects of donor AKI status on graft outcomes after KT in Asian population. Thus, the purpose of this study was to evaluate graft function after KTs from donors with AKI compared to matched KTs from donors without AKI using a multicenter cohort in Korea.MethodsWe analyzed a total of 1,466 KTs collected in Korean Organ Transplant Registry between April 2014 and December 2017. KTs from AKI donors (defined as donors with serum creatinine level ≥ 2 mg/dL) and non-AKI donors (275 cases for each group) were enrolled using a 1:1 propensity score matching. Graft outcomes including graft and patient survival, delayed graft function (DGF), rejection rate, and serially measured estimated glomerular filtration rate (eGFR) were evaluated.ResultsAfter propensity matching, KTs from AKI donors showed higher rate of DGF (44.7% vs. 24.0%, p < 0.001). However, the rejection rate was not significantly different between the two groups (KTs from AKI donors vs. KTs from non-AKI donors). eGFRs measured after 6 months, 1 year, 2 years and 3 years were not significantly different by donor AKI status. With median follow-up duration of 3.52 years, cox proportional hazards models revealed hazard ratio of 0.973 (95% confidence interval [CI], 0.584 to 1.621), 1.004 (95% CI, 0.491 to 2.054) and 0.808 (95% confidence interval [CI], 0.426 to 1.532) for overall graft failure, death-censored graft failure and patient mortality, respectively, in KTs from AKI donors compared to KTs from non-AKI donors as a reference.ConclusionsKTs from AKI donors showed comparable outcomes to KTs from non-AKI donors, despite a higher incidence of DGF. Results of this study supports the validity of using kidneys from deceased AKI donors in Asian population.
Highlights
Kidney transplantation (KT) is the treatment of choice for eligible patients with end-stage renal disease (ESRD) which is superior to any other treatment modalities including renal replacement therapies [1, 2]
Results of this study supports the validity of using kidneys from deceased acute kidney injury (AKI) donors in Asian population
Among 1,466 deceased donor kidney transplantation (KT) performed between April 2014 and December 2017 and identified from the Korean Organ Transplant Registry (KOTRY) database, 275 KTs from donors with AKI were matched at 1:1 to 275 from donors without AKI according to the propensity score
Summary
Kidney transplantation (KT) is the treatment of choice for eligible patients with end-stage renal disease (ESRD) which is superior to any other treatment modalities including renal replacement therapies [1, 2]. Accumulating clinical evidence including long-term observations supports comparable patient survival and graft survival of KT from donors with and without AKI [5,6,7,8,9,10,11,12]. Favorable long-term and short-term graft survival and patient survival after kidney transplantation (KT) from deceased donors with acute kidney injury (AKI) have been reported. Few studies have evaluated effects of donor AKI status on graft outcomes after KT in Asian population.
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