Impact of acute kidney injury on graft outcomes of deceased donor kidney transplantation: A nationwide registry-based matched cohort study in Korea
Open Access
- 17 November 2021
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 16 (11), e0260076
- https://doi.org/10.1371/journal.pone.0260076
Abstract
Favorable long-term and short-term graft survival and patient survival after kidney transplantation (KT) from deceased donors with acute kidney injury (AKI) have been reported. However, few studies have evaluated effects of donor AKI status on graft outcomes after KT in Asian population. Thus, the purpose of this study was to evaluate graft function after KTs from donors with AKI compared to matched KTs from donors without AKI using a multicenter cohort in Korea. We analyzed a total of 1,466 KTs collected in Korean Organ Transplant Registry between April 2014 and December 2017. KTs from AKI donors (defined as donors with serum creatinine level ≥ 2 mg/dL) and non-AKI donors (275 cases for each group) were enrolled using a 1:1 propensity score matching. Graft outcomes including graft and patient survival, delayed graft function (DGF), rejection rate, and serially measured estimated glomerular filtration rate (eGFR) were evaluated. After propensity matching, KTs from AKI donors showed higher rate of DGF (44.7% vs. 24.0%, p < 0.001). However, the rejection rate was not significantly different between the two groups (KTs from AKI donors vs. KTs from non-AKI donors). eGFRs measured after 6 months, 1 year, 2 years and 3 years were not significantly different by donor AKI status. With median follow-up duration of 3.52 years, cox proportional hazards models revealed hazard ratio of 0.973 (95% confidence interval [CI], 0.584 to 1.621), 1.004 (95% CI, 0.491 to 2.054) and 0.808 (95% confidence interval [CI], 0.426 to 1.532) for overall graft failure, death-censored graft failure and patient mortality, respectively, in KTs from AKI donors compared to KTs from non-AKI donors as a reference. KTs from AKI donors showed comparable outcomes to KTs from non-AKI donors, despite a higher incidence of DGF. Results of this study supports the validity of using kidneys from deceased AKI donors in Asian population.Funding Information
- Korea Centers for Disease Control and Prevention (2014-ER6301-00, 2014-ER6301-01, 2014-ER6301-02, 2017-ER6301-00, 2017-ER6301-01, 2017-ER6301-02)
- Korea University
This publication has 34 references indexed in Scilit:
- Impact of Cold Ischemia Time on Graft Survival Among ECD Transplant Recipients: A Paired Kidney AnalysisAmerican Journal of Transplantation, 2011
- Glomerular Filtration Rate Slopes Have Significantly Improved Among Renal Transplants in the United StatesTransplantation, 2010
- Analysis of factors that affect outcome after transplantation of kidneys donated after cardiac death in the UK: a cohort studyThe Lancet, 2010
- A Comprehensive Risk Quantification Score for Deceased Donor Kidneys: The Kidney Donor Risk IndexTransplantation, 2009
- Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney InjuryAmerican Journal of Transplantation, 2009
- Successful Transplantation of Kidneys from Deceased Donors with Acute Renal Failure: Three-Year ResultsTransplantation, 2006
- Assessing Kidney Function — Measured and Estimated Glomerular Filtration RateThe New England Journal of Medicine, 2006
- Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors1Transplantation, 2002
- RECIPIENT BODY SURFACE AREA AS A PREDICTOR OF POSTTRANSPLANT RENAL ALLOGRAFT EVOLUTION1Transplantation, 1998
- THE EFFECT OF KIDNEY SIZE ON CADAVERIC RENAL ALLOGRAFT OUTCOME1Transplantation, 1996