Florian G Scurt1, Angela Ernst2, Tamara Wassermann3, Ben Hammoud3, Peter R Mertens3, Anke Schwarz4, Jan U Becker5, Christos Chatzikyrkou6. 1. University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Medical Faculty, Otto-Von Guericke University Magdeburg, Magdeburg, Germany. florian.scurt@med.ovgu.de. 2. Institute of Medical Statistics and Bioinformatics, University of Cologne, Cologne, Germany. 3. University Clinic for Nephrology and Hypertension, Diabetology and Endocrinology, Medical Faculty, Otto-Von Guericke University Magdeburg, Magdeburg, Germany. 4. Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany. 5. Institute of Pathology, University Hospital of Cologne, Cologne, Germany. 6. Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany. chatziky@gmx.de.
Abstract
BACKGROUND: Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies. METHODS: This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated. RESULTS: Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; ORStage 1: 1.435 (95% CI 0.438-0.702), ORStage 2: 2.463 (95% CI 0.656-9.245), ORStage 3: 4.784 (95% CI 1.421-16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates. CONCLUSION: The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.
BACKGROUND: Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies. METHODS: This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated. RESULTS: Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; ORStage 1: 1.435 (95% CI 0.438-0.702), ORStage 2: 2.463 (95% CI 0.656-9.245), ORStage 3: 4.784 (95% CI 1.421-16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates. CONCLUSION: The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.
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: 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: C Boffa; F van de Leemkolk; E Curnow; J Homan van der Heide; J Gilbert; E Sharples; R J Ploeg Journal: Am J Transplant Date: 2016-08-25 Impact factor: 8.086