Results of Kidney Transplantation From Deceased Donors With Acute Kidney Injury M. Molinaa,*, J. Apazaa, E. González Montea, E. Gutiérrez Martíneza, A.M. Sevillanoa, J.P. Marínb, N. Polancoa, A. Hernándeza, M. Pragaa, and A. Andrésa a
Hospital 12 de Octubre, Madrid, Spain; and bHospital San Pedro de Alcántara, Cáceres, Spain
ABSTRACT Background. Different strategies have been initiated to shorten the waiting list time to receive a kidney transplant. Donors with acute kidney injury (AKI) may be a new option. Methods. Fifty-nine patients received a kidney transplant from an AKI donor defined as having serum creatinine >2 mg/dL at the time of organ procurement. They were compared with a transplant group with normal kidney function defined as creatinine 2 mg/dL. The results were compared with a group of kidney transplant recipients from deceased brain donors, paired according to donor age with normal renal function in the same period (control group, CG). Immunosuppression consisted of steroids, calcineurin inhibitor (CI), mycophenolate mofetil/mycophenolic acid, or azathioprine. In the AKI group, there was a change in the immunosuppression protocol. In recent years, lymphocyte-depleting antibodies were used to perform delayed introduction of the CI. In the CG, lymphocyte-depleting antibodies were used in higheimmunologicalrisk patients. The baseline characteristics of the donor, recipient, and subsequent evolution were collected retrospectively. Values are expressed as mean standard deviation or medium (range). The data were analyzed with the use of the Statistical Package for the Social Services Program, SPSS, Inc, Chicago, Ill, United States, version 15.0 for Windows. The Student t test was used to compare continuous variables, c2 to compare qualitative variables, and *Address correspondence to Maria Molina, Nephrology Department, Hospital 12 de Octubre, Avda Córdoba SN, 28041 Madrid, Spain. E-mail: [email protected] ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 47, 42e44 (2015)
KIDNEY TRANSPLANT FROM DECEASED DONORS WITH AKI
43
Table 1. Baseline and Evolution Characteristics
No. of recipients Recipient data Age (years) Male First kidney transplant PRA No. of HLA mismatches Donor data Age (years) Male CVD as cause of death Maximum serum creatinine OP Transplantation Cold ischemia time (hours) Primary non-function Delayed graft function No. of hemodialysis events No. of days of admission Evolution Acute rejection Graft survival at 1 year Recipient survival at 1 year Serum creatinine at 1 year (mg/dL) Final graft survival Final recipient survival Final serum creatinine (mg/dL) Follow-up (months)
AKI
CG
59
59
52 13 61% (31) 93% (53) 8.2 18 (0e82) 3.6 1.1
50 13 61% (31) 100% (59) 1 3 (0e18) 3.3 1.1
NS NS NS
Hospital 12 de Octubre, Madrid, Spain; and bHospital San Pedro de Alcántara, Cáceres, Spain
ABSTRACT Background. Different strategies have been initiated to shorten the waiting list time to receive a kidney transplant. Donors with acute kidney injury (AKI) may be a new option. Methods. Fifty-nine patients received a kidney transplant from an AKI donor defined as having serum creatinine >2 mg/dL at the time of organ procurement. They were compared with a transplant group with normal kidney function defined as creatinine 2 mg/dL. The results were compared with a group of kidney transplant recipients from deceased brain donors, paired according to donor age with normal renal function in the same period (control group, CG). Immunosuppression consisted of steroids, calcineurin inhibitor (CI), mycophenolate mofetil/mycophenolic acid, or azathioprine. In the AKI group, there was a change in the immunosuppression protocol. In recent years, lymphocyte-depleting antibodies were used to perform delayed introduction of the CI. In the CG, lymphocyte-depleting antibodies were used in higheimmunologicalrisk patients. The baseline characteristics of the donor, recipient, and subsequent evolution were collected retrospectively. Values are expressed as mean standard deviation or medium (range). The data were analyzed with the use of the Statistical Package for the Social Services Program, SPSS, Inc, Chicago, Ill, United States, version 15.0 for Windows. The Student t test was used to compare continuous variables, c2 to compare qualitative variables, and *Address correspondence to Maria Molina, Nephrology Department, Hospital 12 de Octubre, Avda Córdoba SN, 28041 Madrid, Spain. E-mail: [email protected] ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
Transplantation Proceedings, 47, 42e44 (2015)
KIDNEY TRANSPLANT FROM DECEASED DONORS WITH AKI
43
Table 1. Baseline and Evolution Characteristics
No. of recipients Recipient data Age (years) Male First kidney transplant PRA No. of HLA mismatches Donor data Age (years) Male CVD as cause of death Maximum serum creatinine OP Transplantation Cold ischemia time (hours) Primary non-function Delayed graft function No. of hemodialysis events No. of days of admission Evolution Acute rejection Graft survival at 1 year Recipient survival at 1 year Serum creatinine at 1 year (mg/dL) Final graft survival Final recipient survival Final serum creatinine (mg/dL) Follow-up (months)
AKI
CG
59
59
52 13 61% (31) 93% (53) 8.2 18 (0e82) 3.6 1.1
50 13 61% (31) 100% (59) 1 3 (0e18) 3.3 1.1
NS NS NS
