BACKGROUND: Kidney transplantation from deceased donors with terminal acute kidney injury (AKI) is not widely accepted. STUDY DESIGN: Acute kidney injury donor kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level and a terminal SCr level >2.0 mg/dL before organ recovery. RESULTS: Over 5.5 years, we transplanted 84 AKI donor kidneys, including 64 kidneys from standard criteria donors (SCD), 11 from expanded criteria donors (ECD), and 9 from donation after cardiac death (DCD) donors. Mean donor age was 36 years (range 15 to 68 years); mean admission and terminal donor SCr levels were 1.25 mg/dL and 3.2 mg/dL, respectively (mean terminal estimated glomerular filtration rate 25.5 mL/minute). With a mean follow-up of 35 months (range 6 to 70 months), actual patient and graft survival rates are 98% and 89%, respectively, which are numerically, but not statistically, higher than concurrent kidney transplants from brain-dead (non-AKI) SCDs at our center. Delayed graft function (DGF) occurred in 34 patients (40%). Mean 1-, 12-, and 24-month SCr levels were 1.8, 1.6, and 1.7 mg/dL, respectively. Delayed graft function was associated with lower 3-year graft survival for non-AKI SCD transplants (68% vs 90%, with and without DGF), but there was no impact of DGF on graft survival for AKI donor kidneys (89% vs 91%). CONCLUSIONS: Although AKI donor kidneys more commonly have DGF, the higher rate of DGF does not worsen graft outcomes. Kidneys from deceased donors with terminal AKI transplanted into appropriately selected patients have excellent medium-term outcomes and represent a method to safely expand the donor pool.
BACKGROUND: Kidney transplantation from deceased donors with terminal acute kidney injury (AKI) is not widely accepted. STUDY DESIGN:Acute kidney injurydonor kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level and a terminal SCr level >2.0 mg/dL before organ recovery. RESULTS: Over 5.5 years, we transplanted 84 AKI donor kidneys, including 64 kidneys from standard criteria donors (SCD), 11 from expanded criteria donors (ECD), and 9 from donation after cardiac death (DCD) donors. Mean donor age was 36 years (range 15 to 68 years); mean admission and terminal donor SCr levels were 1.25 mg/dL and 3.2 mg/dL, respectively (mean terminal estimated glomerular filtration rate 25.5 mL/minute). With a mean follow-up of 35 months (range 6 to 70 months), actual patient and graft survival rates are 98% and 89%, respectively, which are numerically, but not statistically, higher than concurrent kidney transplants from brain-dead (non-AKI) SCDs at our center. Delayed graft function (DGF) occurred in 34 patients (40%). Mean 1-, 12-, and 24-month SCr levels were 1.8, 1.6, and 1.7 mg/dL, respectively. Delayed graft function was associated with lower 3-year graft survival for non-AKI SCD transplants (68% vs 90%, with and without DGF), but there was no impact of DGF on graft survival for AKI donor kidneys (89% vs 91%). CONCLUSIONS: Although AKI donor kidneys more commonly have DGF, the higher rate of DGF does not worsen graft outcomes. Kidneys from deceased donors with terminal AKI transplanted into appropriately selected patients have excellent medium-term outcomes and represent a method to safely expand the donor pool.
Authors: Peter P Reese; Isaac E Hall; Francis L Weng; Bernd Schröppel; Mona D Doshi; Rick D Hasz; Heather Thiessen-Philbrook; Joseph Ficek; Veena Rao; Patrick Murray; Haiqun Lin; Chirag R Parikh Journal: J Am Soc Nephrol Date: 2015-09-15 Impact factor: 10.121
Authors: Isaac E Hall; Enver Akalin; Jonathan S Bromberg; Mona D Doshi; Tom Greene; Meera N Harhay; Yaqi Jia; Sherry G Mansour; Sumit Mohan; Thangamani Muthukumar; Peter P Reese; Bernd Schröppel; Pooja Singh; Heather R Thiessen-Philbrook; Francis L Weng; Chirag R Parikh Journal: Kidney Int Date: 2018-11-20 Impact factor: 10.612
Authors: I E Hall; B Schröppel; M D Doshi; J Ficek; F L Weng; R D Hasz; H Thiessen-Philbrook; P P Reese; C R Parikh Journal: Am J Transplant Date: 2015-03-11 Impact factor: 8.086
Authors: Jeremy Puthumana; Isaac E Hall; Peter P Reese; Bernd Schröppel; Francis L Weng; Heather Thiessen-Philbrook; Mona D Doshi; Veena Rao; Chun Geun Lee; Jack A Elias; Lloyd G Cantley; Chirag R Parikh Journal: J Am Soc Nephrol Date: 2016-07-22 Impact factor: 10.121
Authors: Urs Benck; Peter Schnuelle; Bernd Krüger; Kai Nowak; Thomas Riester; Heiko Mundt; Niklas Lutz; Matthias Jung; Rainer Birck; Bernhard K Krämer; Wilhelm H Schmitt Journal: Int Urol Nephrol Date: 2015-10-26 Impact factor: 2.370
Authors: Neel Koyawala; Peter P Reese; Isaac E Hall; Yaqi Jia; Heather R Thiessen-Philbrook; Sherry G Mansour; Mona D Doshi; Enver Akalin; Jonathan S Bromberg; Meera N Harhay; Sumit Mohan; Thangamani Muthukumar; Bernd Schröppel; Pooja Singh; Francis L Weng; Chirag R Parikh Journal: Transplantation Date: 2020-06 Impact factor: 5.385