Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case-control study.
BACKGROUND
Whether organs from donors after brain death (DBD) with acute kidney injury (AKI) should be accepted for transplantation is still a matter of debate.


METHODS
This was a retrospective, center-based, matched cohort study of 33 renal transplant patients who received a renal allograft from a DBD with AKI. Sixty-five kidney transplants without donor AKI transplanted directly before and after the index transplantation served as controls.


RESULTS
All AKI donors were classified according to RIFLE criteria: 9.1 % Risk, 54.6 % Injury, and 36.4 % Failure. Mean serum creatinine was 2.41 ± 0.88 mg/dL at procurement and 1.06 ± 0.32 mg/dL on admission. AKI donors had lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009) and received more frequently noradrenaline (93.9 vs. 72.3 %, p = 0.02) and/or adrenaline (15.2 vs. 1.5 %, p = 0.02). Recipient and transplant characteristics were similar except a more favorable HLA match in control patients (p = 0.01). Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 [27.7 %], p = 0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14. One-year graft survival was very similar when comparing the groups (93.6 % [95 % CI 76.8-98.4 %] vs. 90.3 % [95 % CI 79.6-95.5 %], log rank p = 0.58).


CONCLUSIONS
Kidneys from AKI donors can be transplanted with excellent intermediate prognosis and should not be discarded.
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. urs.benck@umm.de.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. urs.benck@umm.de.
Urs
U
Benck
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Peter
P
Schnuelle
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Bernd
B
Krüger
Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Kai
K
Nowak
Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Thomas
T
Riester
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Heiko
H
Mundt
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Niklas
N
Lutz
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Matthias
M
Jung
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Rainer
R
Birck
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. bernhard.kraemer@umm.de.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. bernhard.kraemer@umm.de.
Bernhard K
BK
Krämer
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.|Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Wilhelm H
WH
Schmitt
D058186:Acute Kidney Injury / Q000097:blood* / Q000652:urine; D000328:Adult; D000368:Aged; D001926:Brain Death / Q000097:blood; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D046148:Donor Selection / Q000592:standards; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies
D003404:Creatinine
Acute kidney injury; Delayed graft function; Donor after brain death; Graft survival; Patient survival