title: Transplantation of Kidneys From Donors With Acute Kidney Injury: Friend or Foe?
abstract: The gap between supply and demand in kidney transplantation has led to increased use of marginal kidneys; however, kidneys with acute kidney injury are often declined/discarded. To determine whether this policy is justified, we analyzed outcomes of donor kidneys with acute kidney injury (AKI) in a large UK cohort. A retrospective analysis of the UK Transplant Registry evaluated deceased donors between 2003 and 2013. Donors were classified as no AKI, or AKI stage 1-3 according to Acute Kidney Injury Network (AKIN) criteria. Relationship of AKI with delayed graft function/primary nonfunction (DGF/PNF), estimated glomerular filtration rate (eGFR), and graft-survival at 90 days and 1 year was analyzed. There were 11 219 kidneys (1869 [17%] with AKI) included. Graft failure at 1 year is greater for donors with AKI than for those without (graft survival 89% vs. 91%, p = 0.02; odds ratio (OR) 1.20 [95% confidence interval (CI): 1.03-1.41]). DGF rates increase with donor AKI stage (p < 0.005), and PNF rates are significantly higher for AKIN stage 3 kidneys (9% vs. 4%, p = 0.04) Analysis of association between AKI and recipient eGFR suggests a risk of inferior eGFR with AKI versus no AKI (p < 0.005; OR 1.25 [95% CI: 1.08-1.31]). We report a small reduction in 1-year graft-survival of kidneys from donors with AKI. We conclude that AKI stage 1 or 2 kidneys should be used; however, caution is advised for AKI stage 3 donors.
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Oxford Transplant Centre, Oxford, UK.|NIHR Biomedical Research Centre, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Boffa
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
authors.forename: F
authors.initials: F
authors.lastname: van de Leemkolk
authors.affiliation: NHS Blood and Transplant, Bristol, UK.
authors.forename: E
authors.initials: E
authors.lastname: Curnow
authors.affiliation: Amsterdam Medical Centre, Amsterdam, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Homan van der Heide
authors.affiliation: Oxford Transplant Centre, Oxford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Gilbert
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Oxford Transplant Centre, Oxford, UK.
authors.forename: E
authors.initials: E
authors.lastname: Sharples
authors.affiliation: Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.|Oxford Transplant Centre, Oxford, UK.|NIHR Biomedical Research Centre, Oxford, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ploeg
mesh_terms: D058186:Acute Kidney Injury / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D002102:Cadaver; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: clinical research/practice; donors and donation: deceased; kidney (allograft) function/dysfunction; kidney transplantation/nephrology; organ acceptance