Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney Injury

Utilization and long‐term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by stan...

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Bibliographic Details
Published in:American journal of transplantation 2009-02, Vol.9 (2), p.367-373
Main Authors: Kayler, L. K., Garzon, P., Magliocca, J., Fujita, S., Kim, R. D., Hemming, A. W., Howard, R., Schold, J. D.
Format: Article
Language:English
Subjects:
Acute kidney injury
Acute Kidney Injury - therapy
Adolescent
Adult
Biological and medical sciences
Creatinine - blood
Delayed Graft Function
Donor Selection
Female
Graft Survival - physiology
Humans
Immunosuppressive Agents - therapeutic use
kidney transplantation
Kidney Transplantation - statistics & numerical data
Kidneys
Male
Medical sciences
Nephrology. Urinary tract diseases
Odds Ratio
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Time Factors
Tissue Donors
Treatment Outcome
Urinary system involvement in other diseases. Miscellaneous
Young Adult
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Summary:Utilization and long‐term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ≤1.5, 1.6–2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6–2.0 and >2.0 mg/dL, compared to ≤1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5–7.6) and 1.6–2.0 mg/dL (AOR 2.7; CI 2.5–2.9) relative to sCr ≤1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury. Although in potential standard criteria donors elevated terminal creatinine is a strong risk factor for kidney discard, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2008.02505.x