Transplantation with kidneys retrieved from deceased donors with acute renal failure

• Published in: Transplantation Vol. 95; no. 4; pp. 611 - 616
• Main Authors: Klein, Rodrigo, Galante, Nelson Zocoler, de Sandes-Freitas, Tainá Veras, de Franco, Marcello Fabiano, Tedesco-Silva, Hélio, Medina-Pestana, José Osmar
• Format: Journal Article
• Language: English
• Published: United States 27-02-2013
• Subjects: Acute Kidney Injury - mortality; Acute Kidney Injury - physiopathology; Adolescent; Adult; Biomarkers - blood; Chi-Square Distribution; Creatinine; Creatinine - blood; Delayed Graft Function - etiology; Donors; Female; Graft Rejection - etiology; Graft Survival; Humans; Kaplan-Meier Estimate; Kidney - physiopathology; Kidney - surgery; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nephrectomy; Renal failure; Renal function; Retrospective Studies; Risk Assessment; Risk Factors; Survival; Time Factors; Tissue Donors - supply & distribution; Treatment Outcome; Young Adult
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/TP.0b013e318279153c

The discard rate of kidneys recovered from deceased donors with acute renal failure (ARF) is higher compared with those without ARF mainly due to the uncertainty regarding short-term and long-term outcomes.
We retrospectively analyzed 1-year patient, graft, and rejection-free survivals and renal function of transplantations performed with kidneys recovered from deceased donors with or without ARF, defined as serum creatinine level of more than 1.5 mg/dL. We performed multivariable analysis to evaluate whether ARF was an independent risk factor associated with inferior outcomes.
Of a total of 1518 patients, 253 received kidneys from expanded-criteria donors (ECD; with ARF [n=116] and without ARF [n=137]) and 1265 from standard-criteria donors (SCD; with ARF [n=369] and without ARF [n=896]). The incidence of delayed graft function was higher in ECD (68.1% vs. 58.4%; P=0.072) and SCD (69.9% vs. 50.6%; P<0.001) recipients of kidneys with ARF compared with those without ARF, respectively. At 1 year, patient, graft, and rejection-free survivals were not statistically different in SCD or ECD recipients with or without ARF. Renal function at 1 year was similar in recipients of ECD (41.9±26.3 vs. 40.1±21.7 mL/min; P=0.565) or SCD (50.9±29.9 vs. 53.6±28.5 mL/min; P=0.131) kidneys with and without ARF, respectively. Compared with kidneys without ARF, receiving a kidney allograft with ARF was not associated with increased risk of death, graft lost, or inferior renal function 1 year after transplantation.
In this cohort of patients, kidneys from deceased donors with ARF provided graft survival and renal function comparable with kidneys from donors without ARF 1 year after transplantation.