Published findings indicate kidneys from deceased donors with AKI had recipient graft survival comparable to that of non-AKI kidneys and should, therefore, be considered for use in transplantation.
“The shortage of deceased donor kidneys for transplants is an ongoing concern,” Caroline Liu, MHS, of the Johns Hopkins University School of Medicine, and colleagues wrote. “Prior studies support transplanting kidneys from deceased donors with acute kidney injury, but those investigations have been subject to selection bias and small sample sizes.”
Researchers matched 6,722 deceased donors with AKI to 6,722 deceased donors without AKI who had at least one kidney transplanted between 2010 and 2013. Graft survival was considered in 25,323 recipients, with a median follow-up of 5 years.
Researchers found no association between deceased donor AKI status and death-censored graft failure (HR = 1.01) or all-cause graft failure (HR = 0.97), even after considering AKI stage or adjusting for recipient and transplant characteristics.
Although deceased donor AKI was associated with increased risk for delayed graft function (experienced by 29% of recipients with AKI kidneys vs. 22% of those without; relative risk = 1.34), researchers argued that AKI kidneys have a similar lack of sustained risk to non-AKI kidneys because graft failure rates were comparable between the two. However, additional interventions during initial follow-up — including extra dialysis sessions, modified immunosuppression regiments and close recipient monitoring — may be required.
The researchers added that “substantial changes to the organ procurement system” will be required if the goal — set forth by Advancing American Kidney Health — of doubling the number of kidneys available for transplant by 2030 is to be met.
“From our study’s findings, we believe that the transplant community should continue to use deceased donor AKI kidneys and consider research to investigate whether currently discarded AKI kidneys from deceased donors without substantial comorbidities can be used more effectively,” they wrote. – by Melissa J. Webb
Disclosures: Liu reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.