C C Yu1, H C Ho2, T M Yu3, Y C Ou1, K H Shu3, C L Cheng1, C K Su1, W M Chen1, S S Wang1, C S Chen1, J R Li1, C K Yang1. 1. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan. 2. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address: brainhcho@gmail.com. 3. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Abstract
OBJECTIVES: High terminal serum creatinine level in a deceased donor has been reported as the second most frequent cause of refusal for kidney transplantation. A growing body of evidence has shown a comparable outcome of kidney transplantation from deceased donors with acute kidney injury (AKI). However, the influence of the severity of AKI on graft outcomes remains to be elucidated. METHODS: In this retrospective cohort study, 84 consecutive kidney transplants from 57 standard-criteria donors were classified into 4 groups by RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) classification according to donor AKI severity before kidney procurement. The donor and recipient characteristics and graft outcomes were compared. RESULTS: Of 84 kidney transplants, 56, 11, 10, and 7 recipients were in the Non-AKI, Risk, Injury, and Failure groups. The mean terminal creatinine was 1.1, 1.6, 2.3, and 4.4 mg/dL in these 4 groups. However, the graft outcomes, including primary nonfunction rate, delayed graft function rate, acute rejection rate, renal function, graft survival and overall survival over the first 5 years had no statistical difference. A trend toward increasing delayed graft function rate as the severity of AKI increased was observed (Non-AKI, Risk, Injury, and Failure: 26.8%, 36.4%, 60.0%, and 57.1%, P = .099). CONCLUSIONS: Our study demonstrates that AKI before procurement does not cause adverse long-term graft outcomes. Standard-criteria donors with AKI are suitable for kidney transplantation, even with a high severity of AKI.
OBJECTIVES: High terminal serum creatinine level in a deceased donor has been reported as the second most frequent cause of refusal for kidney transplantation. A growing body of evidence has shown a comparable outcome of kidney transplantation from deceased donors with acute kidney injury (AKI). However, the influence of the severity of AKI on graft outcomes remains to be elucidated. METHODS: In this retrospective cohort study, 84 consecutive kidney transplants from 57 standard-criteria donors were classified into 4 groups by RIFLE (Risk, Injury, Failure, Loss of function, and End-stage renal disease) classification according to donor AKI severity before kidney procurement. The donor and recipient characteristics and graft outcomes were compared. RESULTS: Of 84 kidney transplants, 56, 11, 10, and 7 recipients were in the Non-AKI, Risk, Injury, and Failure groups. The mean terminal creatinine was 1.1, 1.6, 2.3, and 4.4 mg/dL in these 4 groups. However, the graft outcomes, including primary nonfunction rate, delayed graft function rate, acute rejection rate, renal function, graft survival and overall survival over the first 5 years had no statistical difference. A trend toward increasing delayed graft function rate as the severity of AKI increased was observed (Non-AKI, Risk, Injury, and Failure: 26.8%, 36.4%, 60.0%, and 57.1%, P = .099). CONCLUSIONS: Our study demonstrates that AKI before procurement does not cause adverse long-term graft outcomes. Standard-criteria donors with AKI are suitable for kidney transplantation, even with a high severity of AKI.
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: Jana Bauer; Sascha Grzella; Malwina Bialobrzecka; Lea Berger; Timm H Westhoff; Richard Viebahn; Peter Schenker Journal: Ann Transplant Date: 2018-12-07 Impact factor: 1.530
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