Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar 3;17(3):e0264329.
doi: 10.1371/journal.pone.0264329. eCollection 2022.

Clinically adjudicated deceased donor acute kidney injury and graft outcomes

Sherry G Mansour  1   2 , Nadeen Khoury  3 , Ravi Kodali  2 , Sarthak Virmani  2 , Peter P Reese  4   5   6 , Isaac E Hall  7 , Yaqi Jia  8 , Yu Yamamoto  1 , Heather R Thiessen-Philbrook  8 , Wassim Obeid  8 , Mona D Doshi  9 , Enver Akalin  10 , Jonathan S Bromberg  11   12 , Meera N Harhay  13   14   15 , Sumit Mohan  16   17 , Thangamani Muthukumar  18   19 , Pooja Singh  20 , Francis L Weng  21 , Dennis G Moledina  1   2 , Jason H Greenberg  1   2 , Francis P Wilson  1   2 , Chirag R Parikh  8
Affiliations

Clinically adjudicated deceased donor acute kidney injury and graft outcomes

Sherry G Mansour et al. PLoS One. .

Abstract

Background: Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association.

Methods: In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes.

Results: Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI.

Conclusion: iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow diagram.
Shows the breakdown of our study. A total of 428 donors with available charts were included in our study. Among the 428 donors, 291 had AKI at anytime point during the hospitalization. Only donors with AKI were adjudicated, and 106 were found to have hemodynamic AKI, 101 mixed AKI and 84 intrinsic AKI.
Fig 2
Fig 2. Associations of AKI phenotypes with DGF and 1-year eGFR.
Shows the independent associations between AKI phenotypes as compared to hemodynamic AKI and the outcomes of delayed graft function and 1-year eGFR. The exposure of AKI phenotypes is shown both as defined by AKI happening anytime during donor hospitalization as well as AKI at time of organ procurement.
See this image and copyright information in PMC

References

    1. OPTN Transplant Trends by Center 2019 [cited 2020 Feburary 3rd]. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/center-data/.
    1. Hall IE, Schroppel B, Doshi MD, Ficek J, Weng FL, Hasz RD, et al.. Associations of deceased donor kidney injury with kidney discard and function after transplantation. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2015;15(6):1623–31. Epub 2015/03/13. doi: 10.1111/ajt.13144 ; PubMed Central PMCID: PMC4563988. - DOI - PMC - PubMed
    1. Mohan S, Chiles MC, Patzer RE, Pastan SO, Husain SA, Carpenter DJ, et al.. Factors leading to the discard of deceased donor kidneys in the United States. Kidney Int. 2018;94(1):187–98. Epub 2018/05/08. doi: 10.1016/j.kint.2018.02.016 ; PubMed Central PMCID: PMC6015528. - DOI - PMC - PubMed
    1. Yu K, King K, Husain SA, Dube GK, Stevens JS, Ratner LE, et al.. Kidney nonprocurement in solid organ donors in the United States. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2020;20(12):3413–25. Epub 2020/04/29. doi: 10.1111/ajt.15952 . - DOI - PMC - PubMed
    1. Dictus C, Vienenkoetter B, Esmaeilzadeh M, Unterberg A, Ahmadi R. Critical care management of potential organ donors: our current standard. Clin Transplant. 2009;23 Suppl 21:2–9. Epub 2009/12/16. doi: 10.1111/j.1399-0012.2009.01102.x . - DOI - PubMed

Publication types