Abstract
Due to shortage of donor, kidney transplants (KTs) from donors with acute kidney injury (AKI) are expanding. Although previous studies comparing clinical outcomes between AKI and non-AKI donors in KTs have shown comparable results, data on high-volume analysis of KTs outcomes with AKI donors are limited. This study aimed to analyze the selection trends of AKI donors and investigate the impact of AKI on graft failure using the United states cohort data. We analyzed a total 52,757 KTs collected in the Scientific Registry of Transplant Recipient (SRTR) from 2010 to 2015. The sample included 4,962 (9.4%) cases of KTs with AKI donors (creatinine ≥ 2 mg/dL). Clinical characteristics of AKI and non-AKI donors were analyzed and outcomes of both groups were compared. We also analyzed risk factors for graft failure in AKI donor KTs. Although the incidence of delayed graft function was higher in recipients of AKI donors compared to non-AKI donors, graft and patient survival were not significantly different between the two groups. We found donor hypertension, cold ischemic time, the proportion of African American donors, and high KDPI were risk factors for graft failure in AKI donor KTs. KTs from deceased donor with AKI showed comparable outcomes. Thus, donors with AKI need to be considered more actively to expand donor pool. Caution is still needed when donors have additional risk factors of graft failure.
Highlights
Kidney transplantation is the most effective treatment to improve the survival and quality of life for patients with end-stage renal disease [1–3]
This study cohort consisted of 52,757 adult deceased donor kidney transplants (DDKTs) in the U.S alone between January 1, 2010 and December 31, 2015
Proportions of extended criteria donors (ECDs) and those with hypertension (HTN) history over 10 years were lower in the acute kidney injury (AKI) group compared to those in the non-AKI group (12.3% vs. 16.4%, p < 0.0001 and 14.1% vs. 19.1%, p < 0.0001, respectively) (Table 1)
Summary
Kidney transplantation is the most effective treatment to improve the survival and quality of life for patients with end-stage renal disease [1–3]. The discrepancy between donor demand and supply is causing an increase in waiting time for kidney transplantation [4]. As a result of long waiting time, many candidates become ineligible for due to deteriorating clinical. Kidney transplants and acute kidney injury donor interpretation by the SRTR or the U.S Government
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