title: Associations of deceased donor kidney injury with kidney discard and function after transplantation.
abstract: Deceased donor kidneys with acute kidney injury (AKI) are often discarded due to fear of poor outcomes. We performed a multicenter study to determine associations of AKI (increasing admission-to-terminal serum creatinine by AKI Network stages) with kidney discard, delayed graft function (DGF) and 6-month estimated glomerular filtration rate (eGFR). In 1632 donors, kidney discard risk increased for AKI stages 1, 2 and 3 (compared to no AKI) with adjusted relative risks of 1.28 (1.08-1.52), 1.82 (1.45-2.30) and 2.74 (2.0-3.75), respectively. Adjusted relative risk for DGF also increased by donor AKI stage: 1.27 (1.09-1.49), 1.70 (1.37-2.12) and 2.25 (1.74-2.91), respectively. Six-month eGFR, however, was similar across AKI categories but was lower for recipients with DGF (48 [interquartile range: 31-61] vs. 58 [45-75] ml/min/1.73m(2) for no DGF, p < 0.001). There was significant favorable interaction between donor AKI and DGF such that 6-month eGFR was progressively better for DGF kidneys with increasing donor AKI (46 [29-60], 49 [32-64], 52 [36-59] and 58 [39-71] ml/min/1.73m(2) for no AKI, stage 1, 2 and 3, respectively; interaction p = 0.05). Donor AKI is associated with kidney discard and DGF, but given acceptable 6-month allograft function, clinicians should consider cautious expansion into this donor pool.
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT.|Section of Nephrology, Yale University School of Medicine, New Haven, CT.
authors.forename: I E
authors.initials: IE
authors.lastname: Hall
authors.affiliation: Section of Nephrology, Department of Internal Medicine 1, University Hospital, Ulm, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schröppel
authors.affiliation: Wayne State University, Detroit, MI.
authors.forename: M D
authors.initials: MD
authors.lastname: Doshi
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: J
authors.initials: J
authors.lastname: Ficek
authors.affiliation: Barnabas Health, Livingston, NJ.
authors.forename: F L
authors.initials: FL
authors.lastname: Weng
authors.affiliation: Gift of Life Institute, Philadelphia, PA.
authors.forename: R D
authors.initials: RD
authors.lastname: Hasz
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: P P
authors.initials: PP
authors.lastname: Reese
authors.affiliation: Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, CT.|Section of Nephrology, Yale University School of Medicine, New Haven, CT.|Veterans Affairs Connecticut Healthcare System, New Haven, CT.
authors.forename: C R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D000328:Adult; D064591:Allografts; D001706:Biopsy; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014019:Tissue Donors
keywords: deceased; delayed graft function (DGF); donors and donation; kidney failure/injury; organ acceptance