AKI Shouldn't Preclude Kidney Donation, Study Shows

Troy Brown, RN

November 21, 2018

Use of kidneys from deceased donors with acute kidney injury (AKI) appears safe in multiyear follow-up and could make many more organs available for transplant, a multicenter study has found.

"The decision to accept a deceased-donor kidney offer often is complex and may depend on multiple donor, kidney, and recipient factors, as well as many logistical considerations. Our findings indicate that the current practice of using kidneys from donors with AKI does not adversely affect post-transplant outcomes beyond the first year," the researchers write.

"Additional research likely is needed, however, to determine outcomes for recipients of kidneys from donors with the most severe forms of AKI," they add.

Isaac E. Hall, MD, from the Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, and colleagues published their findings November 20 in Kidney International.

The study enrolled 1679 possible donors, and 1298 were included in the analysis (2430 single kidney transplant recipients). Reasons for exclusion included no kidney transplant, missing laboratory values, or donor age younger than 16 years.  

Overall, 585 (24%) kidneys were from donors with AKI (n = 322), none of whom required dialysis. Donors with AKI were more likely to be black and have underlying hypertension, and had a higher mean kidney donor profile index (KDPI) compared with those who did not have AKI.

Those who received kidneys from donors with AKI were more likely to be older. Kidneys from AKI-affected donors "had a longer mean cold ischemia time, were more likely to undergo machine perfusion, and had slightly more human leukocyte antigen mismatches," the authors write.

The cohort underwent a total combined follow-up of 9479 patient-years and median follow-up of 4.0 years (interquartile range, 3.0-5.0 years). A total of 623 (26%) all-cause graft failures occurred, including 402 deaths and 313 death-censored graft failures.

All-cause graft failure did not differ significantly by donor AKI, occurring in 475 (26%) recipients of kidneys without donor AKI and 148 (25%) recipients of kidneys with donor AKI (P = .94).

"Cumulative incidence curves by donor AKI stage suggested increased graft failure risk in the first year for kidneys from donors with stage 3 AKI, although confidence intervals were wide with only 85 kidneys," the researchers write.

All-cause graft failure within the first year did not differ significantly between donor AKI stages (150 [8%] events without donor AKI, 55 [9%] with any donor AKI, 37 [9%] with stage 1, 8 [7%] with stage 2, and 10 [12%] with stage 3; P = .54). Researchers adjusted for factors including KDPI, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor–recipient gender combinations, delayed graft function, and pre-emptive transplant status.

"In this study involving a large multicenter deceased-donor kidney transplant cohort in the United States, we have shown that the current practice of using donor AKI kidneys is not associated with reduced allograft survival. We found no evidence for effect modification between donor AKI and other known risk factors with regard to allograft survival," the researchers write.

"Furthermore, we found no evidence of a donor AKI effect on a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73 m2 in our detailed subcohort of recipients with rigorous chart review," they add.

The authors have disclosed no relevant financial relationships.

Kidney Int. Published online November 20, 2018. Abstract

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