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Open Access 09-07-2022 | Acute Kidney Injury | Nephrology - Original Paper

Short-term outcomes after transplantation of deceased donor kidneys with acute kidney injury: a retrospective analysis of a multicenter cohort of marginal donor kidneys with post-explantation biopsies

Authors: Florian G. Scurt, Angela Ernst, Tamara Wassermann, Ben Hammoud, Peter R. Mertens, Anke Schwarz, Jan U. Becker, Christos Chatzikyrkou

Published in: International Urology and Nephrology | Issue 1/2023

Abstract

Background

Deceased donor kidneys with acute kidney injury (AKI) are often discarded because of concerns about inferior transplant outcomes. A means of grading the quality of such kidneys is the performance of procurement biopsies.

Methods

This is a retrospective study of 221 brain death donors with marginal kidneys transplanted in 223 recipients in Germany. Marginal kidneys were defined as kidneys with procurement biopsies done exceptionally to assess suitability for transplantation in otherwise potentially discarded organs. The impact of deceased donor AKI on patient survival and death-censored graft survival at 1, 3 and 5 years and graft function at 1 and 3 years after transplantation was investigated.

Results

Recipients of kidneys with stage 3 AKI had a greater incidence of delayed graft function [DGF; OR_{Stage 1}: 1.435 (95% CI 0.438–0.702), OR_{Stage 2}: 2.463 (95% CI 0.656–9.245), OR_{Stage 3}: 4.784 (95% CI 1.421–16.101)] but a similar graft and patient survival compared to recipients of donors without AKI and with AKI stage 1 and 2 as well. The coexistence of recipient DGF and donor AKI was associated with the lowest graft survival and function rates.

Conclusion

The transplantation of deceased donor marginal kidneys with AKI confers a higher risk for DGF but is associated with acceptable graft and patient outcomes, which do not differ in comparison with marginal donor kidneys without AKI. Graft prognosis is especially poor if donor AKI and recipient DGF concur. Donor AKI was a risk factor independent of the histological lesions of procurement biopsies.

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Title: Short-term outcomes after transplantation of deceased donor kidneys with acute kidney injury: a retrospective analysis of a multicenter cohort of marginal donor kidneys with post-explantation biopsies
Authors: Florian G. Scurt
Angela Ernst
Tamara Wassermann
Ben Hammoud
Peter R. Mertens
Anke Schwarz
Jan U. Becker
Christos Chatzikyrkou
Publication date: 09-07-2022
Publisher: Springer Netherlands
Keywords: Acute Kidney Injury
Brain Death
Acute Kidney Injury
Published in: International Urology and Nephrology / Issue 1/2023
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-022-03277-3

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Abstract

Background

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