Impact of deceased donor with acute kidney injury on subsequent kidney transplant outcomes-an ANZDATA registry analysis.

Juan Pei,Ross S Francis,Philip A Clayton,Carolyn Van Eps,Carmel M Hawley,Yong Pey See,Nicole M Isbel,Wai Lim,Michael Collins,Germaine Wong,Scott B Campbell,Jeremy Chapman,Elaine M Pascoe,Yeoungjee Cho,Andrea K Viecelli,David W Johnson,Wen Tang,Frank Jmf Dor

doi:10.1371/journal.pone.0249000

Abstract

BackgroundThe need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature.Material and methodsThis observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. The association of donor-AKI, defined according to KDIGO criteria, with all-cause graft failure was evaluated by multivariable Cox regression. Secondary outcomes included death-censored graft failure, death, delayed graft function (DGF) and acute rejection.ResultsThe study included 10,101 recipients of kidneys from 5,774 deceased donors, of whom 1182 (12%) recipients received kidneys from 662 (11%) donors with AKI. There were 3,259 (32%) all-cause graft failures, which included 1,509 deaths with functioning graft. After adjustment for donor, recipient and transplant characteristics, donor AKI was not associated with all-cause graft failure (adjusted hazard ratio [HR] 1.11, 95% CI 0.99–1.26), death-censored graft failure (HR 1.09, 95% CI 0.92–1.28), death (HR 1.15, 95% CI 0.98–1.35) or graft failure when death was evaluated as a competing event (sub-distribution hazard ratio [sHR] 1.07, 95% CI 0.91–1.26). Donor AKI was not associated with acute rejection but was associated with DGF (adjusted odds ratio [OR] 2.27, 95% CI 1.92–2.68).ConclusionDonor AKI stage was not associated with any kidney transplant outcome, except DGF. Use of kidneys with AKI for transplantation appears to be justified.

Highlights

Kidney transplantation is an important treatment for end-stage kidney disease (ESKD) since individuals receiving kidney transplants generally have better survival and quality of life compared with those who remain on dialysis [1,2,3]
After adjustment for donor, recipient and transplant characteristics, donor acute kidney injury (AKI) was not associated with all-cause graft failure, death-censored graft failure (HR 1.09, 95% confidence interval (CI) 0.92–1.28), death (HR 1.15, 95% CI 0.98–1.35) or graft
Donor AKI stage was not associated with any kidney transplant outcome, except delayed graft function (DGF)

Summary

Introduction

Kidney transplantation is an important treatment for end-stage kidney disease (ESKD) since individuals receiving kidney transplants generally have better survival and quality of life compared with those who remain on dialysis [1,2,3]. Given that the availability of suitable donor kidneys is limited and insufficient to meet the needs of the increasing numbers of patients with ESKD, there have been attempts in recent years to expand the criteria for donor kidneys that are considered potentially suitable for transplantation [4]. One such consideration is deceased donors with acute kidney injury (AKI). In a recent study from the United States, AKI defined by Acute Kidney Injury Network criteria occurred in up to 24% of all deceased donors and could potentially contribute significantly to the pool of kidneys offered for transplantation [5]. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature

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