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Review
. 2023 Oct;37(10):e15115.
doi: 10.1111/ctr.15115. Epub 2023 Aug 30.

Single center experience and literature review of kidney transplantation from non-ideal donors with acute kidney injury: Risk and reward

Christopher J Webb  1 , Emily McCracken  1 , Colleen L Jay  1 , Berjesh Sharda  1 , Matthew Garner  1 , Alan C Farney  1 , Giuseppe Orlando  1 , Amber Reeves-Daniel  2 , Alejandra Mena-Gutierrez  2 , Natalia Sakhovskaya  2 , Bobby Stratta  1 , Robert J Stratta  1
Affiliations
Review

Single center experience and literature review of kidney transplantation from non-ideal donors with acute kidney injury: Risk and reward

Christopher J Webb et al. Clin Transplant. 2023 Oct.

Abstract

Introduction: There is limited experience transplanting kidneys from either expanded criteria donors (ECD) or donation after circulatory death (DCD) deceased donors with terminal acute kidney injury (AKI).

Methods: AKI kidneys were defined by a donor terminal serum creatinine level >2.0 mg/dL whereas non-ideal deceased donor (NIDD) kidneys were defined as AKI/DCD or AKI/ECDs.

Results: From February 2007 to March 2023, we transplanted 266 single AKI donor kidneys including 29 from ECDs, 29 from DCDs (n = 58 NIDDs), and 208 from brain-dead standard criteria donors (SCDs). Mean donor age (43.7 NIDD vs. 33.5 years SCD), KDPI (66% NIDD vs. 45% SCD), and recipient age (57 NIDD vs. 51 years SCD) were higher in the NIDD group (all p < .01). Mean waiting times (17.8 NIDD vs. 24.2 months SCD) and dialysis duration (34 NIDD vs. 47 months SCD) were shorter in the NIDD group (p < .05). Delayed graft function (DGF, 48%) and 1-year graft survival (92.7% NIDD vs. 95.9% SCD) was similar in both groups. Five-year patient and kidney graft survival rates were 82.1% versus 89.9% and 82.1% versus 75.2% (both p = NS) in the NIDD versus SCD groups, respectively.

Conclusions: The use of kidneys from AKI donors can be safely liberalized to include selected ECD and DCD donors.

Keywords: acute kidney injury; delayed graft function; donation after circulatory death; expanded criteria donors; non-ideal donors; standard criteria donors.

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References

REFERENCES

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    1. Port FK, Bragg JL, Metzger RA, et al. Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors. Transplantation. 2002;74:1281-1286.
    1. Stratta RJ, Rohr MS, Sundberg AK, et al. Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation. Ann Surg. 2006;243(5):594-601.
    1. Abt PL, Fisher CA, Singhal AK. Donation after cardiac death in the US: history and use. J Am Coll Surg. 2006;203(2):208-225.
    1. Farney AC, Hines MH, Al-Geizawi S, et al. Lessons learned from a single center's experience with 134 donation after cardiac death donor kidney transplants. J Am Coll Surg. 2011;2012:440-453.

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