title: Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries.
abstract: OBJECTIVE
  To evaluate and compare the outcomes of kidney transplant (KT) from deceased donors among standard criteria, acute kidney injury (AKI) and expanded criteria donors (ECDs).
  
  
  METHODS
  This retrospective study included 111 deceased donor kidney transplant recipients (DDKT). Deceased donors were classified as standard criteria donor (SCD), AKI donor and ECD. AKI was diagnosed and classified based on change of serum Cr by acute kidney injury network (AKIN) criteria. Primary outcome was one-year estimated glomerular filtration rate (eGFR) calculated from Cr by CKD-EPI. Multivariate regression analysis was done by adjusting factors such as type of DDKT, %Panel-reactive antibodies, cold ischemic time, the presence of delayed graft function and the use of induction therapy. Significant factors that can affect the primary outcomes were then identified.
  
  
  RESULTS
  ECD group had a significantly lower eGFR at one year (33.9 ± 17.3 mL/min) when compared with AKI group (56.6 ± 23.9) and SCD group (63.6 ± 19.9) (P< 0.001). For AKI group, one-year eGFR was also indifferent among AKIN stage 1, 2 or 3. Patients with AKIN stage 3 had progressive increase of eGFR from 49.6 ± 27.2 at discharge to 61.9 ± 29.0 mL/min at one year. From Kaplan-Meier analysis, AKI donor showed better two-year graft survival than ECD (100%vs88.5%,P= 0.006). Interestingly, AKI group had a stable eGFR at one and two year. The two-year eGFR of AKI group was not significantly different from SCD group (56.6 ± 24.5 mL/minvs58.6 ± 23.2 mL/min,P= 0.65).
  
  
  CONCLUSIONS
  Kidney transplantations from deceased donors with variable stage of acute kidney injuries were associated with favorable two-year allograft function. The outcomes were comparable with KT from SCD. This information supports the option that deceased donors with AKI are an important source of organ for kidney transplantation even in the presence of stage 3 AKI.
authors.affiliation: Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Punlop
authors.initials: P
authors.lastname: Wiwattanathum
authors.affiliation: Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Atiporn
authors.initials: A
authors.lastname: Ingsathit
authors.affiliation: Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Surasak
authors.initials: S
authors.lastname: Kantachuvesiri
authors.affiliation: Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Nuttapon
authors.initials: N
authors.lastname: Arpornsujaritkun
authors.affiliation: Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Wiwat
authors.initials: W
authors.lastname: Tirapanich
authors.affiliation: Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Vasant
authors.initials: V
authors.lastname: Sumethkul
keywords: Acute kidney injury donor; Acute kidney injury network stage; Deceased donor; Estimated glomerular filtration rate stabilization; Rising of terminal serum creatinine; Stabilize allograft function