Expanded Criteria Donor With Severe Acute Kidney Injury: Worth to Use?
Issued Date
2022-10-01
Resource Type
ISSN
00411345
eISSN
18732623
Scopus ID
2-s2.0-85139070896
Pubmed ID
36195498
Journal Title
Transplantation Proceedings
Volume
54
Issue
8
Start Page
2097
End Page
2102
Rights Holder(s)
SCOPUS
Bibliographic Citation
Transplantation Proceedings Vol.54 No.8 (2022) , 2097-2102
Suggested Citation
Thotsiri S., Sutharattanapong N., Janphram C., Wiwattanathum P. Expanded Criteria Donor With Severe Acute Kidney Injury: Worth to Use?. Transplantation Proceedings Vol.54 No.8 (2022) , 2097-2102. 2102. doi:10.1016/j.transproceed.2022.08.036 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85489
Title
Expanded Criteria Donor With Severe Acute Kidney Injury: Worth to Use?
Author's Affiliation
Other Contributor(s)
Abstract
Background: Expanded criteria donors (ECDs) may present with acute kidney injury (AKI). Many transplantation centers refuse to use these kidneys because of concerns about poor transplant outcomes, resulting in a high discard rate. However, long-term results of ECDs with AKI (ECDs + AKI) have not been extensively studied. Methods: We retrospectively compared outcomes of ECDs with ECDs + AKI. Primary outcome was 5-year allograft and patient survival rate. Secondary outcomes were allograft function, rates of delayed graft function, and allograft rejection. Results: Of 743 deceased donor kidney transplant recipients, 95 ECD cases were included in this study. There were 38 patients (40%) with ECDs and 57 patients (60%) with ECDs + AKI. Mean donor creatinine was progressively higher with severity of AKI. Five-year graft and patient survival were comparable between ECDs and ECDs + AKI (80.6% vs 81.1%, P =.95 and 91.7% vs 88.7%, P =.73). Mean (SD) allograft estimated glomerular filtration rate was 36.7 (14.5) vs 40.6 (22.7) mL/min/1.73 m2 with P =.61, respectively. Multivariate analysis showed factors associated graft loss were delayed graft function (P =.01) and donor-recipient age difference ≥10 years (P =.038), not AKI status. Conclusions: Kidney transplant from ECDs + AKI has comparable allograft survival with ECDs without AKI. Use of ECDs + AKI is worthwhile and kidneys from ECDs + AKI should not be discarded. Recipient selection and perioperative care are important to optimize the use of scarce resource.