Impact of deceased donor with acute kidney injury on subsequent kidney transplant outcomes–an ANZDATA registry analysis

Juan Pei, Yeoungjee Cho, Yong Pey See, Elaine M Pascoe, Andrea K Viecelli, Ross S Francis, Carolyn van Eps, Nicole M Isbel, Scott B Campbell, Philip A Clayton, Jeremy Chapman, Michael Collins, Wai Lim, Wen Tang, Germaine Wong, Carmel M Hawley and David W Johnson

PLOS ONE, 2021, vol. 16, issue 3, 1-19

Abstract: 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.

Date: 2021
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0249000

DOI: 10.1371/journal.pone.0249000

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