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Kidney Week

Abstract: PO2402

Successful Transplantation Outcomes Using Deceased Donors with AKI

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Harshman, Amy L., Miami Transplant Institute, Miami, Florida, United States
  • Preczewski, Luke, Miami Transplant Institute, Miami, Florida, United States
  • Muldoon, Meghan, Miami Transplant Institute, Miami, Florida, United States
  • Guerra, Giselle, Miami Transplant Institute, Miami, Florida, United States
Background

Kidneys from deceased donors with acute kidney injury (AKI) are discarded at a higher rate than those without AKI, exacerbating the organ shortage. This paper reviews outcomes of kidneys from deceased donors with AKI over a four-year period at a single transplant center.

Methods

We analyzed 1119 consecutive deceased donor kidney adult recipients transplanted from 2016 through 2019 at our center. Donors were classified using AKIN criteria for AKI based on increase of terminal serum creatinine (SCr) over initial SCr. Death-censored graft survival and eGFR (MDRD) were compared.

Results

911 recipients received kidneys from donors with no AKI (Stage 0). 208 (18.6%) received kidneys from donors with AKI. 45 (4.02%) had Stage 1 AKI, 59 (5.27%) had Stage 2 AKI, and 104 (9.29%) had Stage 3 AKI. There were no significant differences between the AKI and non-AKI groups in recipient age, gender, ethnicity, or Estimated Post-Transplant Survival score.
Using a Cox Proportional Hazards Model, death-censored graft survival at 1 year was not distinguishable between recipients whose donor had any stage of AKI versus donors without AKI (HR 0.94, p=0.854) nor among AKI stages (Figure 1). Mean eGFR by MDRD formula for recipients alive and with followup at 1 year was 60.0 (SD 23.2) in recipients with non-AKI donors and 61.9 (SD 26.1) in recipients with AKI donors, which was of no statistical significance (p=0.4384). The rate of delayed graft function was significantly higher in recipients from AKI donors (62.0%) versus non-AKI donors (31.5%), p<0.0001.

Conclusion

Recipients of AKI donors did not yield inferior outcomes to those of non-AKI donors at 1 year. Increased DGF can be anticipated, but does not appear to have any lasting impact on graft survival or renal function. As such, transplant centers should consider expanding the use of these kidneys for any waitlisted candidate.

Funding

  • Clinical Revenue Support