Annals of Surgical Treatment and Research

The Korean Surgical Society (대한외과학회)
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Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

  • Ko, Kyung Jai (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kim, Young Hwa (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kim, Mi Hyeong (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Jun, Kang Woong (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Kyung Hye (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hyung Sook (Organ Transplant Center, Seoul St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Sang Dong (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Park, Sun Cheol (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Kim, Ji Il (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Yun, Sang Seob (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Moon, In Sung (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea) ;
  • Hwang, Jeong Kye (Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea)
  • Received : 2018.01.16
  • Accepted : 2018.06.08
  • Published : 2018.11.01
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Abstract

Purpose: We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI). Methods: Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38). Results: The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024). Conclusion: Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

References

  1. Lo CM. Deceased donation in Asia: challenges and opportunities. Liver Transpl 2012;18 Suppl 2:S5-7. https://doi.org/10.1002/lt.23545
  2. Jung CW, Park KT, Kim SY, Kim SJ, Kim MG, Jo SK, et al. Clinical outcomes in kidney transplantation patients from deceased donors with acute kidney injury. Transplant Proc 2013;45:2941-5. https://doi.org/10.1016/j.transproceed.2013.08.048
  3. Korean Network for Ogran Sharing. 2016 Annual data report [Internet]. Seoul: Korean Network for Ogran Sharing; [cited 2017 Sep 8]. Available from: http://konos.go.kr.
  4. Merion RM, Ashby VB, Wolfe RA, Distant DA, Hulbert-Shearon TE, Metzger RA, et al. Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 2005;294:2726-33. https://doi.org/10.1001/jama.294.21.2726
  5. Summers DM, Johnson RJ, Allen J, Fuggle SV, Collett D, Watson CJ, et al. Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort study. Lancet 2010;376:1303-11. https://doi.org/10.1016/S0140-6736(10)60827-6
  6. de Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000;26:915-21. https://doi.org/10.1007/s001340051281
  7. Bonventre JV, Yang L. Cellular pathophysiology of ischemic acute kidney injury. J Clin Invest 2011;121:4210-21. https://doi.org/10.1172/JCI45161
  8. Anil Kumar MS, Khan SM, Jaglan S, Heifets M, Moritz MJ, Saeed MI, et al. Successful transplantation of kidneys from deceased donors with acute renal failure: Three-year results. Transplantation 2006;82:1640-5. https://doi.org/10.1097/01.tp.0000250908.62948.8f
  9. Ugarte R, Kraus E, Montgomery RA, Burdick JF, Ratner L, Haas M, et al. Excellent outcomes after transplantation of deceased donor kidneys with high terminal creatinine and mild pathologic lesions. Transplantation 2005;80:794-800. https://doi.org/10.1097/01.TP.0000173801.33878.BF
  10. Kellum JA. Diagnostic criteria for acute kidney injury: present and future. Crit Care Clin 2015;31:621-32. https://doi.org/10.1016/j.ccc.2015.06.001
  11. Lee MH, Jeong EG, Chang JY, Kim Y, Kim JI, Moon IS, et al. Clinical outcome of kidney transplantation from deceased donors with acute kidney injury by Acute Kidney Injury Network criteria. J Crit Care 2014;29:432-7. https://doi.org/10.1016/j.jcrc.2013.12.016
  12. Metzger RA, Delmonico FL, Feng S, Port FK, Wynn JJ, Merion RM. Expanded criteria donors for kidney transplantation. Am J Transplant 2003;3 Suppl 4:114-25. https://doi.org/10.1034/j.1600-6143.3.s4.11.x
  13. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31. https://doi.org/10.1186/cc5713
  14. Hoste EA, Kellum JA. Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care 2006;12:531-7. https://doi.org/10.1097/MCC.0b013e3280102af7
  15. Uchino S, Bellomo R, Bagshaw SM, Goldsmith D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant 2010;25:1833-9. https://doi.org/10.1093/ndt/gfp624
  16. Kolonko A, Chudek J, Pawlik A, Wilk J, Jalowiecki P, Wiecek A. Acute kidney injury before organ procurement is associated with worse long-term kidney graft outcome. Transplant Proc 2011;43:2871-4. https://doi.org/10.1016/j.transproceed.2011.07.017
  17. Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant 2011;11:2279-96. https://doi.org/10.1111/j.1600-6143.2011.03754.x
  18. Heilman RL, Devarapalli Y, Chakkera HA, Mekeel KL, Moss AA, Mulligan DC, et al. Impact of subclinical inflammation on the development of interstitial fibrosis and tubular atrophy in kidney transplant recipients. Am J Transplant 2010;10:563-70. https://doi.org/10.1111/j.1600-6143.2009.02966.x
  19. Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet 2004;364:1814-27. https://doi.org/10.1016/S0140-6736(04)17406-0
  20. Chawla LS, Kimmel PL. Acute kidney injury and chronic kidney disease: an integrated clinical syndrome. Kidney Int 2012;82:516-24. https://doi.org/10.1038/ki.2012.208
  21. Macedo E, Bouchard J, Mehta RL. Renal recovery following acute kidney injury. Curr Opin Crit Care 2008;14:660-5. https://doi.org/10.1097/MCC.0b013e328317ee6e
  22. Boffa C, van de Leemkolk F, Curnow E, Homan van der Heide J, Gilbert J, Sharples E, et al. Transplantation of kidneys from donors with acute kidney injury: friend or foe? Am J Transplant 2017;17:411-9.
  23. Hall IE, Schroppel B, Doshi MD, Ficek J, Weng FL, Hasz RD, et al. Associations of deceased donor kidney injury with kidney discard and function after transplantation. Am J Transplant 2015;15:1623-31. https://doi.org/10.1111/ajt.13144
  24. Heilman RL, Smith ML, Kurian SM, Huskey J, Batra RK, Chakkera HA, et al. Transplanting kidneys from deceased donors with severe acute kidney injury. Am J Transplant 2015;15:2143-51 https://doi.org/10.1111/ajt.13260
  25. Farney AC, Rogers J, Orlando G, al-Geizawi S, Buckley M, Farooq U, et al. Evolving experience using kidneys from deceased donors with terminal acute kidney injury. J Am Coll Surg 2013;216:645-55. https://doi.org/10.1016/j.jamcollsurg.2012.12.020
  26. Seo CH, Ju JI, Kim MH, Jun KW, Ahn SH, Hwang JK, et al. Risk factors and longterm outcomes of delayed graft function in deceased donor renal transplantation. Ann Surg Treat Res 2015;89:208-14. https://doi.org/10.4174/astr.2015.89.4.208
  27. Hwang JK, Park SC, Kwon KH, Choi BS, Kim JI, Yang CW, et al. Long-term outcomes of kidney transplantation from expanded criteria deceased donors at a single center: comparison with standard criteria deceased donors. Transplant Proc 2014;46:431-6. https://doi.org/10.1016/j.transproceed.2013.11.061

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