2013 - ISODP 2013 Congress


Mini-Oral 2 on Increasing Donation

9.5 - Community perspectives on the allocation of deceased donor organs for transplantation: a nominal group study

Presenter: Michelle, Irving, Sydney, Australia
Authors: Michelle Irving


Deceased donors with severe acute kidney injury – A potential source to expand the donor pool

Adyr Moss1, Kunam Reddy1, David Mulligan1, Nitin Katariya1, Winston Hewitt1, Ramesh Battra1, Raymond Heilman1, Hasan Khamash1, Harini Chakkera1, Jana Huskey1, Maxwell Smith1

1Transplant Center, Mayo Clinic Arizona, Arizona, AZ, United States

 

Background: Our aim was to determine the outcome of transplanting kidneys from selected donors with severe AKI.

Methods: We selected all patients receiving single organ deceased donor kidney transplant at our center transplanted between June 2004 and October 2012. AKI donor was defined as a donor terminal Cr > 2.0. Donor data was obtained from UNET. The acute kidney injury network criteria  (AKIN) were used to stage the severity of the AKI in the donor (stage 1 to 3 with 3 requiring Cr 3 times baseline elevation or increase Cr ≥ 4 or urine output < 0.3 ml/kg for > 24 hours or anuria > 12 hours). Continuous variables are given as mean± 1 SD.

Results: There were 104 in the AKI group and 501 in the non AKI group. Baseline characteristics were similar, except AKI group had longer cold ischemia time (19.8±7.8 vs. 15.6±7.2, p<0.0001), were more likely to be male (76% vs. 57%, p=0.02). HLA mismatch was higher in the AKI group (4.1±1.7 vs. 3.6±2.0, p=0.03). Characteristics of the donors in the AKI group: peak Cr 4.02±1.84, terminal Cr 3.53±1.62, oligoanuric in 39%, renal replacement therapy in 10%. Pulsatile pump was used more often in the AKI group (61% vs. 23%, p<0.0001). Delayed graft function (DGF) was more frequent in the AKI group (69% vs. 27%, p<0.0001).  The Cr at 1 week was higher in the AKI group (4.26±2.18 vs. 2.66±1.95, p<0.0001) but Cr and eGFR at 1 year (yr) were similar. 1 yr protocol biopsy (Bx) findings were not significantly different. Actuarial graft survival was similar at 1 and 3 yr (AKI 92% and 88%, non AKI 92% and 86%). For the AKI group, the kidneys from donors with AKIN stage 3 were more likely to have DGF and a higher Cr at 1 week, but eGFR and Bx findings at 1 yr were similar (table).

 

 

All Kidneys

AKI kidneys only

 

Non AKI donor

(n=501)

All AKI donors

(n=104)

P

AKIN <3

(n=32)

AKIN 3

(n=64)

P

DGF

27%

69%

<0.0001

50%

78%

0.03

Cr  1 week

2.66±1.95

4.26±2.18

<0.0001

3.47±2.20

4.65±2.08

0.01

Cr 1 month

1.72±1.02

1.84±1.22

0.32

1.85± 1.57

1.84± 1.01

0.97

eGFR 1 year

60.0±22.6 (n=328)

60.2±21.9 (n=54)

0.94

58.1±21.8 (n=20)

60.7±20.5 (n=29)

0.70

Banff ci>1 on 1 yr Bx

30% (n=264)

40% (n=43)

0.23

36% (n=11)

38% (n=26)

1.0

Conclusion: Kidneys from AKI donors, including carefully selected donors with severe AKI, have similar outcomes to non AKI donor kidneys. More liberal use of these organs will help relieve the organ shortage.


You must be logged in to view recordings

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Our Corporate Sponsors

TTS gratefully acknowledges the Corporate Partners whose generous support makes the work of the Society possible:

  • astellas
  • roche
  • sanofi