Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 24, 2016; 6(4): 712-718
Published online Dec 24, 2016. doi: 10.5500/wjt.v6.i4.712
Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries
Punlop Wiwattanathum, Atiporn Ingsathit, Surasak Kantachuvesiri, Nuttapon Arpornsujaritkun, Wiwat Tirapanich, Vasant Sumethkul
Punlop Wiwattanathum, Surasak Kantachuvesiri, Vasant Sumethkul, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Atiporn Ingsathit, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Nuttapon Arpornsujaritkun, Wiwat Tirapanich, Vascular and Transplant unit, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Wiwattanathum P, Ingsathit A, Kantachuvesiri S, Arpornsujaritkun N, Tirapanich W and Sumethkul V have been involved in research design, analysis of data, writing manuscript and final approval of the version of the manuscript to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Faculty of Medicine, Ramathibodi Hospital (EC_590514).
Informed consent statement: All involved persons in this study gave informed consent to participate in the study treatment. The analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors report no conflict of interest.
Data sharing statement: The authors do not provide online data sharing. However, those who wish to make collaboration for data sharing should contact the corresponding author.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vasant Sumethkul, MD, Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. vasant.sum@mahidol.ac.th
Telephone: +66-02-2011400
Received: April 26, 2016
Peer-review started: April 27, 2016
First decision: June 16, 2016
Revised: October 20, 2016
Accepted: November 1, 2016
Article in press: November 3, 2016
Published online: December 24, 2016
Processing time: 231 Days and 22.5 Hours
Abstract
AIM

To evaluate and compare the outcomes of kidney transplant (KT) from deceased donors among standard criteria, acute kidney injury (AKI) and expanded criteria donors (ECDs).

METHODS

This retrospective study included 111 deceased donor kidney transplant recipients (DDKT). Deceased donors were classified as standard criteria donor (SCD), AKI donor and ECD. AKI was diagnosed and classified based on change of serum Cr by acute kidney injury network (AKIN) criteria. Primary outcome was one-year estimated glomerular filtration rate (eGFR) calculated from Cr by CKD-EPI. Multivariate regression analysis was done by adjusting factors such as type of DDKT, %Panel-reactive antibodies, cold ischemic time, the presence of delayed graft function and the use of induction therapy. Significant factors that can affect the primary outcomes were then identified.

RESULTS

ECD group had a significantly lower eGFR at one year (33.9 ± 17.3 mL/min) when compared with AKI group (56.6 ± 23.9) and SCD group (63.6 ± 19.9) (P < 0.001). For AKI group, one-year eGFR was also indifferent among AKIN stage 1, 2 or 3. Patients with AKIN stage 3 had progressive increase of eGFR from 49.6 ± 27.2 at discharge to 61.9 ± 29.0 mL/min at one year. From Kaplan-Meier analysis, AKI donor showed better two-year graft survival than ECD (100% vs 88.5%, P = 0.006). Interestingly, AKI group had a stable eGFR at one and two year. The two-year eGFR of AKI group was not significantly different from SCD group (56.6 ± 24.5 mL/min vs 58.6 ± 23.2 mL/min, P = 0.65).

CONCLUSION

Kidney transplantations from deceased donors with variable stage of acute kidney injuries were associated with favorable two-year allograft function. The outcomes were comparable with KT from SCD. This information supports the option that deceased donors with AKI are an important source of organ for kidney transplantation even in the presence of stage 3 AKI.

Keywords: Acute kidney injury donor; Rising of terminal serum creatinine; Acute kidney injury network stage; Deceased donor; Estimated glomerular filtration rate stabilization; Stabilize allograft function

Core tip: Many concerns about problems from using kidneys donated from donors who had acute kidney injury (AKI) before organ procurement lead to underutilization of such kidneys. Several kidneys have unnecessary been discarded in recent year. Here, we describe the comparable allograft and patient outcomes between using kidney from standard criteria donor and donor with AKI. Kidney transplantations from deceased donors with variable stages of acute kidney injuries were associated with favorable allograft function. This information supports the option that deceased donors with AKI are an important source of organ for kidney transplantation and can remedy the problem of organ shortage.