title: Preimplant histologic acute tubular necrosis and allograft outcomes.
abstract: OBJECTIVE
  The influence of deceased-donor AKI on post-transplant outcomes is poorly understood. The few published studies about deceased-donor preimplant biopsy have reported conflicting results regarding associations between AKI and recipient outcomes.
  
  
  METHODS
  This multicenter study aimed to evaluate associations between deceased-donor biopsy reports of acute tubular necrosis (ATN) and delayed graft function (DGF), and secondarily for death-censored graft failure, first adjusting for the kidney donor risk index and then stratifying by donation after cardiac death (DCD) status.
  
  
  RESULTS
  Between March 2010 and April 2012, 651 kidneys (369 donors, 4 organ procurement organizations) were biopsied and subsequently transplanted, with ATN reported in 110 (17%). There were 262 recipients (40%) who experienced DGF and 38 (6%) who experienced graft failure. DGF occurred in 45% of kidneys with reported ATN compared with 39% without ATN (P=0.31) resulting in a relative risk (RR) of 1.13 (95% confidence interval [95% CI], 0.9 to 1.43) and a kidney donor risk index-adjusted RR of 1.11 (95% CI, 0.88 to 1.41). There was no significant difference in graft failure for kidneys with versus without ATN (8% versus 5%). In stratified analyses, the adjusted RR for DGF with ATN was 0.97 (95% CI, 0.7 to 1.34) for non-DCD kidneys and 1.59 (95% CI, 1.23 to 2.06) for DCD kidneys (P=0.02 for the interaction between ATN and DCD on the development of DGF).
  
  
  CONCLUSIONS
  Despite a modest association with DGF for DCD kidneys, this study reveals no significant associations overall between preimplant biopsy-reported ATN and the outcomes of DGF or graft failure. The potential benefit of more rigorous ATN reporting is unclear, but these findings provide little evidence to suggest that current ATN reports are useful for predicting graft outcomes or deciding to accept or reject allograft offers.
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut;, †Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut;, ‡University of Pennsylvania, Philadelphia, Pennsylvania;, §Barnabas Health, Livingston, New Jersey;, ‖University Hospital, Ulm, Germany;, ¶Wayne State University, Detroit, Michigan;, *Gift of Life Institute, Philadelphia, Pennsylvania;, ††New Jersey Sharing Network, New Providence, New Jersey;, ‡‡Mount Sinai School of Medicine and New York Organ Donor Network, New York, New York, §§Section of Nephrology, Veterans Affairs Medical Center, West Haven, Connecticut.
authors.forename: Isaac E
authors.initials: IE
authors.lastname: Hall
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.forename: Francis L
authors.initials: FL
authors.lastname: Weng
authors.forename: Bernd
authors.initials: B
authors.lastname: Schröppel
authors.forename: Mona D
authors.initials: MD
authors.lastname: Doshi
authors.forename: Rick D
authors.initials: RD
authors.lastname: Hasz
authors.forename: William
authors.initials: W
authors.lastname: Reitsma
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldstein
authors.forename: Kwangik
authors.initials: K
authors.lastname: Hong
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D051799:Delayed Graft Function / Q000209:etiology; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States