Deceased-donor acute kidney injury is not associated with kidney allograft failure

Background The need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature. Material and methods This observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. The association of donor-AKI, defined according to KDIGO criteria, with all-cause graft failure was evaluated by multivariable Cox regression. Secondary outcomes included death-censored graft failure, death, delayed graft function (DGF) and acute rejection. Results The study included 10,101 recipients of kidneys from 5,774 deceased donors, of whom 1182 (12%) recipients received kidneys from 662 (11%) donors with AKI. There were 3,259 (32%) all-cause graft failures, which included 1,509 deaths with functioning graft. After adjustment for donor, recipient and transplant characteristics, donor AKI was not associated with all-cause graft failure (adjusted hazard ratio [HR] 1.11, 95% CI 0.99–1.26), death-censored graft failure (HR 1.09, 95% CI 0.92–1.28), death (HR 1.15, 95% CI 0.98–1.35) or graft failure when death was evaluated as a competing event (sub-distribution hazard ratio [sHR] 1.07, 95% CI 0.91–1.26). Donor AKI was not associated with acute rejection but was associated with DGF (adjusted odds ratio [OR] 2.27, 95% CI 1.92–2.68). Conclusion Donor AKI stage was not associated with any kidney transplant outcome, except DGF. Use of kidneys with AKI for transplantation appears to be justified.

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OUTCOMES OF DECEASED DONOR KIDNEY TRANSPLANTATION USING KIDNEYS FROM DONORS WITH ACUTE KIDNEY INJURY

Transplantation Journal ◽

10.1097/01.tp.0000700284.31878.52 ◽

2020 ◽

Vol 104 (S3) ◽

pp. S346-S346

Author(s):

Kyeongdeok Kim ◽

Manuel Lim ◽

Jieun Kwon ◽

Eunsung Jeong ◽

Jaehun Yang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Transplantation ◽

Kidney Injury ◽

Deceased Donor ◽

Donor Kidney ◽

Deceased Donor Kidney ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

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Low Preoperative Antithrombin III level is Associated with Postoperative Acute Kidney Injury after Liver Transplantation

10.21203/rs.3.rs-259177/v1 ◽

2021 ◽

Author(s):

Kyoung-Sun Kim ◽

Young-Jin Moon ◽

Sung-Hoon Kim ◽

In-Gu Jun ◽

Hye-Mee Kwon ◽

...

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Animal Studies ◽

Antithrombin Iii ◽

Kidney Injury ◽

High Body Mass Index ◽

Deceased Donor ◽

Meld Score ◽

Red Blood Cell Transfusion ◽

Duration Of Surgery

Abstract Background: The reno-protective effect of Antithrombin III (ATIII) has been well-studied in various animal studies; however, little is known about the effect of ATIII on kidney function in patients undergoing liver transplantation (LT). This study aimed to determine the association between preoperative ATIII level and postoperative acute kidney injury (AKI) after LT (post-LT AKI).Methods: We retrospectively evaluated 2,395 LT recipients between 2010 and 2018 whose data of perioperative ATIII levels were available. Patients were divided into two groups based on the preoperative level of ATIII (ATIII<50% vs. ATIII≥50%). Multivariable regression analysis was performed to assess the risk factors for post-LT AKI. In addition, subgroup analysis for the Model for End-stage liver disease (MELD) score (<20, ≥20) and donor types (deceased vs. living) were performed to identify the predictive value of ATIII.Results: The mean preoperative ATIII levels were 30.2±11.8% in the ATIII<50% group and 67.2±13.2% in the ATIII≥50% group. The incidence of post-LT AKI was significantly lower in ATIII≥50% group compared to that in the ATIII<50% group (54.7% vs. 75.5%, P<0.001; odds ratio [OR, per 10% increase of ATIII level] 0.86, 95% confidence interval [CI] 0.81–0.92; P<0.001). The prognostic value of ATIII was found to be statistically significant in the low-MELD group (<20, OR 0.82, 95% CI 0.77–0.87, P<0.001) and living donor LT (OR 0.89, CI 0.85–0.94, P<0.001) group. After a backward stepwise regression model, female sex, high body mass index, low albumin, deceased donor LT, longer duration of surgery, and high red blood cell transfusion remained significantly associated with post-LT AKI.Conclusion: Low preoperative ATIII level is associated with post-LT AKI, suggesting that preoperative ATIII might be a prognostic factor for predicting post-LT AKI.

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