Expanding the Utilization of Kidneys from Donors with Acute Kidney Injury
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KIDNEY TRANSPLANTATION (M HENRY AND R PELLETIER, SECTION EDITORS)
Expanding the Utilization of Kidneys from Donors with Acute Kidney Injury Caroline C. Jadlowiec 1 & Raymond L. Heilman 2 & Margaret S. Ryan 3 & K. Sudhakar Reddy 1
# Springer Nature Switzerland AG 2020
Abstract Purpose of Review Our aim is to review the experience with transplanting kidneys from decreased donors with acute kidney injury (AKI). Recent Findings The discard rate is higher for kidneys from AKI donors. Studies have uniformly shown that the risk of delayed graft function (DGF) is higher. However, the majority of studies have shown that other outcomes including short and long graft survival, eGFR, and risk of rejection are not inferior with transplanting AKI donor kidneys. To select AKI donor kidneys, we depend on preimplantation biopsy to exclude AKI kidneys with > 10% cortical necrosis or more than mild chronic changes. Although the DGF rate is higher, we have been able to safely discharge patients by POD 2 and manage DGF as an outpatient. Summary It is estimated that if the transplant community used appropriately selected kidneys from AKI donors, there would be almost 600 additional transplants done each year in the US. Keywords Deceased donor kidney transplantation . Deceased donors with acute kidney injury . Delayed graft function in kidney transplantation
Introduction The imbalance between patients with end-stage renal disease (ESRD) who are listed for kidney transplant and the number of available deceased donors continues to widen. Previous studies have documented that certain categories of donors such as high kidney donor profile index (KDPI) and public health service (PHS) increased risk donors that offer survival advantage for patients with ESRD; however, many centers have been reluctant to use organs because of perceived higher risk. Donors with acute kidney injury (AKI) are another category of donors which are underutilized. The discard rate for This article is part of the Topical Collection on Kidney Transplantation * Raymond L. Heilman [email protected] 1
Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
2
Department of Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
3
Department of Laboratory Medicine and Pathology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
kidneys from donors with AKI remains high because of concern for poor outcome; however, most studies have demonstrated good outcomes with transplanting these kidneys. In this review, we will review the published studies on transplanting kidneys from deceased donors with AKI. We will also describe the clinical processes our center has adopted which have allowed us to successfully transplant these kidneys.
High Discard Rates for AKI Donor Kidneys According to the 2017 Scientific Registry of Transplant Recipients (SRTR) annual report, 34.0% of kidneys from donors with a terminal creatinine > 1.5 mg/dL were discarded as compared to 14.0% for kidneys from donors with terminal creati
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