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Associations of Deceased Donor Kidney Injury With Kidney Discard and Function After Transplantation
Author(s) -
Hall I. E.,
Schröppel B.,
Doshi M. D.,
Ficek J.,
Weng F. L.,
Hasz R. D.,
ThiessenPhilbrook H.,
Reese P. P.,
Parikh C. R.
Publication year - 2015
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13144
Subject(s) - medicine , acute kidney injury , renal function , interquartile range , urology , creatinine , kidney transplantation , kidney , transplantation , kidney disease
Deceased donor kidneys with acute kidney injury (AKI) are often discarded due to fear of poor outcomes. We performed a multicenter study to determine associations of AKI (increasing admission‐to‐terminal serum creatinine by AKI Network stages) with kidney discard, delayed graft function (DGF) and 6‐month estimated glomerular filtration rate (eGFR). In 1632 donors, kidney discard risk increased for AKI stages 1, 2 and 3 (compared to no AKI) with adjusted relative risks of 1.28 (1.08–1.52), 1.82 (1.45–2.30) and 2.74 (2.0–3.75), respectively. Adjusted relative risk for DGF also increased by donor AKI stage: 1.27 (1.09–1.49), 1.70 (1.37–2.12) and 2.25 (1.74–2.91), respectively. Six‐month eGFR, however, was similar across AKI categories but was lower for recipients with DGF (48 [interquartile range: 31–61] vs. 58 [45–75] ml/min/1.73m 2 for no DGF, p < 0.001). There was significant favorable interaction between donor AKI and DGF such that 6‐month eGFR was progressively better for DGF kidneys with increasing donor AKI (46 [29–60], 49 [32–64], 52 [36–59] and 58 [39–71] ml/min/1.73m 2 for no AKI, stage 1, 2 and 3, respectively; interaction p = 0.05). Donor AKI is associated with kidney discard and DGF, but given acceptable 6‐month allograft function, clinicians should consider cautious expansion into this donor pool.