Abstract: FR-PO1042

Can Kidneys from Deceased Donors with AKI and Circulatory Death Be Transplanted?

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Rao, Swati, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
  • Lee, Iris J., Temple University School of Medicine, Philadelphia, Pennsylvania, United States
  • Gillespie, Avrum, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
  • Constantinescu, Serban, Temple University School of Medicine, Philadelphia, Pennsylvania, United States
Background

Kidneys from deceased donors with acute kidney injury (AKI) are often not transplanted despite similar 1 year outcomes as donors without AKI. Our center utilizes a high percentage of AKI donors (15%), including donors with severe AKI requiring renal replacement therapy. We compared the 3 year outcomes of AKI donors after brain death (DBD) and circulatory death (DCD), with non-AKI donors.

Methods

We conducted a retrospective chart review of deceased donor kidney transplant (DDKT) recipients from 1/2011 to 6/2016. AKI was defined as terminal serum creatinine (SCr) of ≥ 1.5mg/dl.

Results

138 eligible DDKT recipients were divided into 4 groups based on donor characteristics: Group 1 [DBD non-AKI, n=73(53%)], Group 2 [DCD non-AKI, n=44 (32%)], Group 3 [DBD-AKI, n=14(10%)], and Group 4 [DCD-AKI, n=7(5%)]. The terminal SCr was significantly higher in DBD-AKI (2.8mg/dl) and DCD-AKI (2.1mg/dl) compared to DBD non-AKI (0.9mg/dl) and DCD non-AKI (0.8mg/dl) (p <0.01). Recipients were 60% male, 65% Caucasian, and mean age of 57±12yrs, with no significant differences among groups. Donors in DCD-AKI group were younger than other groups (24yr vs 35-40yr p=0.02), but all had similar KDPI (43%, p=0.6). Although delayed graft function (DGF) was not different between the groups, the duration of DGF was longer in the DCD non-AKI group than other groups (16d vs 7.5-9d, p=0.04). Patient survival at 1yr, 2yr, and 3yr was 97%, 94% and 97% in group 1, 98%, 93% and 84% in group 2 respectively, and 100% for all years for group 3 and group 4 (p= 0.76, 0.91, and 0.62). Death censored allograft survival at 1yr, 2yr and 3yr was similar between the groups, 98%, 96% and 93% in group 1, 98%, 88%, and 87% in group 2 respectively, and 100% for all years in group 3 and group 4 (p=0.53, 0.70, and 0.93). The SCr was higher and eGFR was lower at 1 month post-KT in the DCD non-AKI group compared to other groups (p <0.01), but both became similar to other groups at 1 yr and remained comparable at 3yr post-transplant. At 3yr, 92% of DBD non-AKI, 86% of DCD non-AKI and 100% of DBD-AKI and DCD-AKI donors had eGFR of more than 30ml/min (p=0.9).

Conclusion

Judicious use of AKI donors had excellent 1yr and 3yr patient and allograft outcomes with no difference between DCD and DBD donors. Selected AKI donors, especially young donors, can be safely utilized to expand the donor pool.