Transplanting kidneys from donation after cardiac death donors with acute kidney injury

Caroline C. Jadlowiec, Raymond L. Heilman, Maxwell L. Smith, Hasan A. Khamash, Janna L. Huskey, Jack Harbell, Kunam S. Reddy, Adyr A. Moss

Research output: Contribution to journalArticle

Abstract

Donation after cardiac death (DCD) and acute kidney injury (AKI) donors have historically been considered independent risk factors for delayed graft function (DGF), allograft failure, and inferior outcomes. With growing experience, updated analyses have shown good outcomes. There continues to be limited data, however, on outcomes specific to DCD donors who have AKI. Primary outcomes for this study were post–kidney transplant patient and allograft survival comparing two donor groups: DCD AKIN stage 2-3 and DBD AKIN stage 2-3. In comparing these groups, there were no short- or long-term differences in patient (hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.54-1.93, P =.83) or allograft survival (HR 1.47, 95% CI 0.64-2.97, P =.32). In multivariate models, the DCD/DBD status had no significant impact on the estimated GFR (eGFR) at 1 (P =.38), 2 (P =.60), and 3 years (P =.52). DGF (57.9% vs 67.9%, P =.09), rejection (12.1% vs 13.9%, P =.12), and progression of interstitial fibrosis/tubular atrophy (IFTA) on protocol biopsy (P =.16) were similar between the two groups. With careful selection, good outcomes can be achieved utilizing severe AKI DCD kidneys. Historic concerns regarding primary nonfunction, DGF resulting in interstitial fibrosis and rejection, and inferior outcomes were not observed. Given the ongoing organ shortage, increased effort should be undertaken to further utilize these donors.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Acute Kidney Injury
Delayed Graft Function
Tissue Donors
Kidney
Allografts
Fibrosis
Confidence Intervals
Atrophy
Outcome Assessment (Health Care)
Transplants
Biopsy

Keywords

  • clinical research/practice
  • delayed graft function (DGF)
  • donors and donation: donation after brain death (DBD)
  • donors and donation: donation after circulatory death (DCD)
  • kidney failure/injury
  • kidney transplantation/nephrology

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Jadlowiec, C. C., Heilman, R. L., Smith, M. L., Khamash, H. A., Huskey, J. L., Harbell, J., ... Moss, A. A. (Accepted/In press). Transplanting kidneys from donation after cardiac death donors with acute kidney injury. American Journal of Transplantation. https://doi.org/10.1111/ajt.15653

Transplanting kidneys from donation after cardiac death donors with acute kidney injury. / Jadlowiec, Caroline C.; Heilman, Raymond L.; Smith, Maxwell L.; Khamash, Hasan A.; Huskey, Janna L.; Harbell, Jack; Reddy, Kunam S.; Moss, Adyr A.

In: American Journal of Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

Jadlowiec, Caroline C. ; Heilman, Raymond L. ; Smith, Maxwell L. ; Khamash, Hasan A. ; Huskey, Janna L. ; Harbell, Jack ; Reddy, Kunam S. ; Moss, Adyr A. / Transplanting kidneys from donation after cardiac death donors with acute kidney injury. In: American Journal of Transplantation. 2019.
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abstract = "Donation after cardiac death (DCD) and acute kidney injury (AKI) donors have historically been considered independent risk factors for delayed graft function (DGF), allograft failure, and inferior outcomes. With growing experience, updated analyses have shown good outcomes. There continues to be limited data, however, on outcomes specific to DCD donors who have AKI. Primary outcomes for this study were post–kidney transplant patient and allograft survival comparing two donor groups: DCD AKIN stage 2-3 and DBD AKIN stage 2-3. In comparing these groups, there were no short- or long-term differences in patient (hazard ratio [HR] 1.07, 95{\%} confidence interval [CI] 0.54-1.93, P =.83) or allograft survival (HR 1.47, 95{\%} CI 0.64-2.97, P =.32). In multivariate models, the DCD/DBD status had no significant impact on the estimated GFR (eGFR) at 1 (P =.38), 2 (P =.60), and 3 years (P =.52). DGF (57.9{\%} vs 67.9{\%}, P =.09), rejection (12.1{\%} vs 13.9{\%}, P =.12), and progression of interstitial fibrosis/tubular atrophy (IFTA) on protocol biopsy (P =.16) were similar between the two groups. With careful selection, good outcomes can be achieved utilizing severe AKI DCD kidneys. Historic concerns regarding primary nonfunction, DGF resulting in interstitial fibrosis and rejection, and inferior outcomes were not observed. Given the ongoing organ shortage, increased effort should be undertaken to further utilize these donors.",
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