Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury

Raymond L. Heilman, Maxwell L. Smith, Byron H. Smith, Anjushree Kumar, Ananth Srinivasan, Janna L. Huskey, Hasan A. Khamash, Caroline C. Jadlowiec, Amit Mathur, Adyr A. Moss, Kunam Sudhakar Reddy

Research output: Contribution to journalArticle

Abstract

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 AKI. 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 >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 1313 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% confidence interval) 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 hazard ratio (95% confidence interval) for the combined endpoint for the AKIN stage 3 group (relative to AKIN 0 group) was 0.70 (0.45-1.10). Delayed graft function 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 < 0.001). CONCLUSION: We conclude that transplanting selected kidneys from deceased donors with AKI with preimplantation biopsy showing <10% cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.

Original languageEnglish (US)
Pages (from-to)e263-e272
JournalTransplantation
Volume103
Issue number9
DOIs
StatePublished - Sep 1 2019

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Acute Kidney Injury
Kidney Transplantation
Tissue Donors
Kidney
Graft Survival
Necrosis
Confidence Intervals
Delayed Graft Function
Transplants
Transplantation
Biopsy

ASJC Scopus subject areas

  • Transplantation

Cite this

Heilman, R. L., Smith, M. L., Smith, B. H., Kumar, A., Srinivasan, A., Huskey, J. L., ... Reddy, K. S. (2019). Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury. Transplantation, 103(9), e263-e272. https://doi.org/10.1097/TP.0000000000002792

Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury. / Heilman, Raymond L.; Smith, Maxwell L.; Smith, Byron H.; Kumar, Anjushree; Srinivasan, Ananth; Huskey, Janna L.; Khamash, Hasan A.; Jadlowiec, Caroline C.; Mathur, Amit; Moss, Adyr A.; Reddy, Kunam Sudhakar.

In: Transplantation, Vol. 103, No. 9, 01.09.2019, p. e263-e272.

Research output: Contribution to journalArticle

Heilman, RL, Smith, ML, Smith, BH, Kumar, A, Srinivasan, A, Huskey, JL, Khamash, HA, Jadlowiec, CC, Mathur, A, Moss, AA & Reddy, KS 2019, 'Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury', Transplantation, vol. 103, no. 9, pp. e263-e272. https://doi.org/10.1097/TP.0000000000002792
Heilman RL, Smith ML, Smith BH, Kumar A, Srinivasan A, Huskey JL et al. Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury. Transplantation. 2019 Sep 1;103(9):e263-e272. https://doi.org/10.1097/TP.0000000000002792
Heilman, Raymond L. ; Smith, Maxwell L. ; Smith, Byron H. ; Kumar, Anjushree ; Srinivasan, Ananth ; Huskey, Janna L. ; Khamash, Hasan A. ; Jadlowiec, Caroline C. ; Mathur, Amit ; Moss, Adyr A. ; Reddy, Kunam Sudhakar. / Long-term Outcomes Following Kidney Transplantation From Donors With Acute Kidney Injury. In: Transplantation. 2019 ; Vol. 103, No. 9. pp. e263-e272.
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abstract = "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 AKI. 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 >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 1313 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{\%} confidence interval) 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 hazard ratio (95{\%} confidence interval) for the combined endpoint for the AKIN stage 3 group (relative to AKIN 0 group) was 0.70 (0.45-1.10). Delayed graft function 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 < 0.001). CONCLUSION: We conclude that transplanting selected kidneys from deceased donors with AKI with preimplantation biopsy showing <10{\%} cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.",
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AU - Heilman, Raymond L.

AU - Smith, Maxwell L.

AU - Smith, Byron H.

AU - Kumar, Anjushree

AU - Srinivasan, Ananth

AU - Huskey, Janna L.

AU - Khamash, Hasan A.

AU - Jadlowiec, Caroline C.

AU - Mathur, Amit

AU - Moss, Adyr A.

AU - Reddy, Kunam Sudhakar

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N2 - 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 AKI. 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 >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 1313 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% confidence interval) 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 hazard ratio (95% confidence interval) for the combined endpoint for the AKIN stage 3 group (relative to AKIN 0 group) was 0.70 (0.45-1.10). Delayed graft function 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 < 0.001). CONCLUSION: We conclude that transplanting selected kidneys from deceased donors with AKI with preimplantation biopsy showing <10% cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.

AB - 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 AKI. 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 >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 1313 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% confidence interval) 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 hazard ratio (95% confidence interval) for the combined endpoint for the AKIN stage 3 group (relative to AKIN 0 group) was 0.70 (0.45-1.10). Delayed graft function 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 < 0.001). CONCLUSION: We conclude that transplanting selected kidneys from deceased donors with AKI with preimplantation biopsy showing <10% cortical necrosis and no more than mild chronic changes have excellent long-term graft survival.

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