Korean J Transplant.  2020 Dec;34(Supple 1):S45. 10.4285/ATW2020.OP-1049.

Safety and effectiveness of kidney transplantation using a donation-after-brain-death donor with acute kidney injury: a retrospective cohort study

Affiliations
  • 1Division of Transplantation, Department of Surgery, Samsung Medical Center, Seoul, Korea

Abstract

Background
The use of kidneys from donation-after-brain-death (DBD) donors with acute kidney injury (AKI) is a strategy to expand the donor pool. However, debate continues about the use of donors with AKI. The aim of this study was to evaluate how kidney transplantation (KT) from a donor with AKI affects long-term graft survival in various situations.
Methods
All patients who underwent KT from DBD donors between June 2003 and April 2016 were retrospectively reviewed. The KDIGO (Kidney Disease: Improving Global Outcomes) criteria were used to classify donor AKI.
Results
The cohort included 376 donors (no AKI group, n=117 [31.1%]; AKI group, n=259 [68.9%]). The delayed graft function (DGF) rate was significantly higher in the AKI group (P<0.001) and tended to increase with AKI stage (P<0.001). Death-censored graft survival was similar according to the presence of AKI, AKI severity, and the AKI trend (P=0.929, P=0.077, and P=0.658, respectively). In addition, death-censored graft survival was similar in expanded criteria donor KT (P=0.617) and the high kidney donor profile index (≥80) group (P=0.420). In the multivariate analysis, patients whose donors had AKI who received using low dose (1.5 mg/kg for 3 days) rabbit anti-thymocyte globulin (r-ATG) as the induction agent had significantly superior death-censored graft survival compared with patients in that group who received basiliximab (P=0.039).
Conclusions
AKI in DBD donors negatively affected the DGF rate. However, it did not affect long-term death-censored graft survival. Low-dose r-ATG can be used for induction immunosuppression in recipients receiving kidneys with AKI because it showed better graft survival than basiliximab.

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