Juan Pei1,2,3,4, Yeoungjee Cho2,3,4, Yong Pey See2,3,5, Elaine M Pascoe3, Andrea K Viecelli2,3, Ross S Francis2, Carolyn van Eps2, Nicole M Isbel2, Scott B Campbell2, Philip A Clayton4,6,7, Jeremy Chapman8, Michael Collins4,9, Wai Lim10, Wen Tang11, Germaine Wong8, Carmel M Hawley2,3,4,12, David W Johnson2,3,4,12. 1. Department of Nephrology, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China. 2. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia. 3. Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, Australia. 4. Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia. 5. Department of Renal Medicine, Tan Tock Seng Hospital, Novena, Singapore. 6. Department of Medicine, The University of Adelaide, Adelaide, Australia. 7. Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia. 8. Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, Australia. 9. Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, New Zealand. 10. Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia. 11. Department of Nephrology, Peking University Third Hospital, Beijing, China. 12. Translational Research Institute, Brisbane, Australia.
Abstract
BACKGROUND: The need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature. MATERIAL AND METHODS: This observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. The association of donor-AKI, defined according to KDIGO criteria, with all-cause graft failure was evaluated by multivariable Cox regression. Secondary outcomes included death-censored graft failure, death, delayed graft function (DGF) and acute rejection. RESULTS: The study included 10,101 recipients of kidneys from 5,774 deceased donors, of whom 1182 (12%) recipients received kidneys from 662 (11%) donors with AKI. There were 3,259 (32%) all-cause graft failures, which included 1,509 deaths with functioning graft. After adjustment for donor, recipient and transplant characteristics, donor AKI was not associated with all-cause graft failure (adjusted hazard ratio [HR] 1.11, 95% CI 0.99-1.26), death-censored graft failure (HR 1.09, 95% CI 0.92-1.28), death (HR 1.15, 95% CI 0.98-1.35) or graft failure when death was evaluated as a competing event (sub-distribution hazard ratio [sHR] 1.07, 95% CI 0.91-1.26). Donor AKI was not associated with acute rejection but was associated with DGF (adjusted odds ratio [OR] 2.27, 95% CI 1.92-2.68). CONCLUSION: Donor AKI stage was not associated with any kidney transplant outcome, except DGF. Use of kidneys with AKI for transplantation appears to be justified.
BACKGROUND: The need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature. MATERIAL AND METHODS: This observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. The association of donor-AKI, defined according to KDIGO criteria, with all-cause graft failure was evaluated by multivariable Cox regression. Secondary outcomes included death-censored graft failure, death, delayed graft function (DGF) and acute rejection. RESULTS: The study included 10,101 recipients of kidneys from 5,774 deceased donors, of whom 1182 (12%) recipients received kidneys from 662 (11%) donors with AKI. There were 3,259 (32%) all-cause graft failures, which included 1,509 deaths with functioning graft. After adjustment for donor, recipient and transplant characteristics, donor AKI was not associated with all-cause graft failure (adjusted hazard ratio [HR] 1.11, 95% CI 0.99-1.26), death-censored graft failure (HR 1.09, 95% CI 0.92-1.28), death (HR 1.15, 95% CI 0.98-1.35) or graft failure when death was evaluated as a competing event (sub-distribution hazard ratio [sHR] 1.07, 95% CI 0.91-1.26). Donor AKI was not associated with acute rejection but was associated with DGF (adjusted odds ratio [OR] 2.27, 95% CI 1.92-2.68). CONCLUSION: Donor AKI stage was not associated with any kidney transplant outcome, except DGF. Use of kidneys with AKI for transplantation appears to be justified.
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