Kidney Transplantation Using Extended Criteria Donor (ECD) Kidneys From Donors With Acute Kidney Injury (AKI).

Abstract

Background: Our aim was to study the outcomes following transplant using ECD AKI compared to ECD non AKI kidneys. Methods: We included all ECD kidneys transplanted at our center between July 2004 and October 2013. We defined AKI as donor with terminal creatinine > 2.0. In this analysis we focused on the outcome following transplant of ECD kidneys with AKI compared to ECD kidneys without AKI. 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 160 ECD kidneys transplanted during this period: 23 in the AKI group and 137 in the control group (ECD Non AKI group). There was no significant difference in baseline recipient characteristics. The mean recipient age was 64.3±7.5, 42.5% were female, 4% were Black race, BMI was 28.9±4.9, 53% were diabetic, 7.5% were re-transplant, 18% were preemptive, mean HLA mismatch 4.2±1.7 and 18% had PRA > 20%. For the AKI group, the donors were younger (56.6±9.1 vs 61.6±9.2, p=0.02), more likely to be male (74% vs 52%, p=0.04) and had longer CIT (22.2±6.9 vs 16.7±7.2 hrs, p=0.001). Additional data for the AKI ECD group: admitting creatinine was 1.11±0.48, peak creatinine 3.68±1.63, terminal creatinine 3.31±1.04, 39% were oligo-anuric and 13% (n=3) were on renal replacement therapy. Delayed graft function (DGF) was more common in the AKI group, but GFR and biopsy findings at 1 yr and graft survival were all similar between the groups.Table: No Caption available.Figure: No Caption available.Conclusion: Outcomes after transplant using AKI ECD kidneys is similar to transplant with ECD kidneys without AKI. There may be an opportunity to increase the utilization of kidneys from AKI ECD donors.