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Long-term outcomes following kidney transplantation from donors with acute kidney injury

Heilman, Raymond L. MD1; Smith, Maxwell L. MD2; Smith, Byron H. PhD3; Kumar, Anjushree MBBS1; Srinivasan, Ananth MBBS4; Huskey, Janna L. MD1; Khamash, Hasan A. MD1; Jadlowiec, Caroline C. MD4; Mathur, Amit K. MD4; Moss, Adyr A. MD4; Kunam, Reddy S. MBBS4

doi: 10.1097/TP.0000000000002792
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Background: Kidneys from deceased donors with acute kidney injury (AKI) are more likely to be discarded because of concerns for poor outcomes after transplantation. The aim of this study was to determine the long-term outcomes of a large cohort of patients transplanted utilizing kidneys from deceased donors with acute kidney injury.

Methods: All patients receiving a deceased donor kidney transplant during a recent 10-year period were included. Acute Kidney Injury Network (AKIN) criteria were used to classify the donors. Donor kidneys with more than 10% cortical necrosis or more than mild chronic changes were discarded. The primary outcome is the combined endpoint of death or graft loss.

Results: The cohort included 1,313 kidneys from 974 donors, AKIN stage 0 (no AKI) in 319 (24.3%), stage 1 in 370 (28.2%), stage 2 in 177 (13.5) and stage 3 in 447 (34.0%). Estimated 5-year graft survival (95% CI) was 78.5% (72.5-84.5), 77.8% (72.8-82.1), 83.8% (76.8-88.9) and 84.6% (79.5-88.7) for AKIN donor stage 0 to 3, respectively (log-rank p=0.10). After adjusting for baseline differences, the HR (95% CI) for the combined endpoint for the AKIN stage 3 group (relative to AKIN 0 group) was 0.70 (0.45-1.10). DGF occurred in 44.6% and 75.4% of AKIN 2 and 3 groups, as compared to 33.9% and 33.5% in AKIN 0 and 1 (p<.001).

Conclusion We conclude that transplanting selected kidneys from deceased donors with AKI with preimplantation biopsy showing less than 10% cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.

1Department of Medicine

2Department of Laboratory Medicine and Pathology

4Department of Surgery, Mayo Clinic, Phoenix, AZ, USA

3Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA

Disclosures: The authors declare no conflicts of interest.

Conclusion: We conclude that transplanting selected kidneys from deceased donors with AKI with pre-implantation biopsy showing less than 10% cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.

Corresponding Author: Raymond L. Heilman, MD, 5777 East Mayo Boulevard, Phoenix, AZ 85054, Email Heilman.raymond@mayo.edu

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