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Success of Kidney Transplantations from Deceased Donors with Acute Kidney Injury

Jana Bauer, Sascha Grzella, Malwina Bialobrzecka, Lea Berger, Timm H. Westhoff, Richard Viebahn, Peter Schenker

(Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany)

Ann Transplant 2018; 23:836-844

DOI: 10.12659/AOT.912660

Published: 2018-12-07

BACKGROUND: The acceptance of organs from deceased donors with acute kidney injury (AKI) varies considerably, with uncertain outcomes. The current organ shortage has led to increased use of marginal donor organs.
MATERIAL AND METHODS: This retrospective, single-center study included 642 patients who underwent kidney allograft transplantation between 2005 and 2016. The recipients were categorized into 3 groups: AKI-1 (n=214), comprising donors with a peak serum creatinine (SCr) level of 1.1–2.0 mg/dl; AKI-2 (n=89), comprising donors with a peak SCr level >2 mg/dl; and non-AKI (n=339), comprising donors with normal kidney function (SCr <1.1 mg/dl).
RESULTS: The cumulative survival rates for patients and grafts did not significantly differ among the AKI-1, AKI-2, and non-AKI groups at the 1-year (91.6%/79.4%, 92.1%/83.1%, 95.3%/88.5%, respectively) and 5-year assessments (79.4%/67.8%, 86.8%/71.7%, 80.5%/71.1%, respectively). These findings were corroborated by mean SCr values and estimated glomerular filtration rates at the 1-year (2.08±1.7/51.16±23.45, 2.01±1.52/56.46±23.63, 1.81±1.13/55.44±23.26 mg/dl, respectively) and 5-year assessments (1.91±1.28/51.06±24.65, 1.74±0.66/57.44±31.21, 1.7±0.88/58.56±26.04 mg/dl, respectively). The incidence of delayed graft function in each group was 29.9%, 44.9%, and 28.6%, respectively.
CONCLUSIONS: Kidney transplantation from donors with AKI, although associated with a higher rate of delayed graft function, results in good long-term transplant survival and reliable kidney functionality after 5 years. The inclusion of donors with AKI may widely extend the pool of available organs; however, careful donor selection is necessary.

Keywords: acute kidney injury, Delayed Graft Function, Graft Survival, Kidney Transplantation