Ann Surg Treat Res.  2018 Nov;95(5):278-285. 10.4174/astr.2018.95.5.278.

Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

• Ko KJ
• Kim YH
• Kim MH
• Jun KW
• Kwon KH
• Kim HS
• Kim SD
• Park SC
• Kim JI
• Yun SS
• Moon IS
• Hwang JK

• KMID: 2422937
• DOI: http://doi.org/10.4174/astr.2018.95.5.278

Abstract

PURPOSE
We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI).
METHODS
Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38).
RESULTS
The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024).
CONCLUSION
Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.

Keyword

Acute kidney injury; Donor selection [E04.936.537.500]; Kidney transplantation

MeSH Terms

Acute Kidney Injury*
Allografts
Brain Death
Delayed Graft Function
Graft Survival
Humans
Incidence
Kidney Transplantation*
Kidney*
Korea*
Survival Rate
Tissue Donors*
Transplants

Figure

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  Fig. 1 Study groups. Group I: Non-AKI & SCD (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); group IV: AKI & ECD (n = 38); AKI, acute kidney injury; SCD, standard criteria donor; ECD, expanded criteria donor.

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  Fig. 2 Change in graft function. AKI, acute kidney injury; SCD, standard criteria donor; ECD, expanded criteria donor; MDRD, modification of diet in renal disease; eGFR, estimated glomerular filtration rate; KT, kidney transplantation.

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  Fig. 3 Graft (A, P = 0.074) and patient survival (B, P = 0.090) among the 4 groups. AKI, acute kidney injury; SCD, standard criteria donor; ECD, expanded criteria donor.

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  Fig. 4 Comparing graft survival (P = 0.024) between group IV and the others (groups I, II, and III). Group I: Non-AKI & SCD (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); group IV: AKI & ECD (n = 38); AKI, acute kidney injury; SCD, standard criteria donor; ECD, expanded criteria donor.

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