Document Type
Article
Publication Date
3-3-2022
Abstract
Background: Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association.
Methods: In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes.
Results: Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI.
Conclusion: iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization.
Recommended Citation
Mansour, Sherry G; Khoury, Nadeen; Kodali, Ravi; Virmani, Sarthak; Reese, Peter P; Hall, Isaac E; Jia, Yaqi; Yamamoto, Yu; Thiessen-Philbrook, Heather R; Obeid, Wassim; Doshi, Mona D; Akalin, Enver; Bromberg, Jonathan S; Harhay, Meera N; Mohan, Sumit; Muthukumar, Thangamani; Singh, Pooja; Weng, Francis L; Moledina, Dennis G; Greenberg, Jason H; Wilson, Francis P; and Parikh, Chirag R, "Clinically adjudicated deceased donor acute kidney injury and graft outcomes" (2022). Department of Medicine Faculty Papers. Paper 343.
https://jdc.jefferson.edu/medfp/343
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
35239694
Language
English
Comments
This article is the author’s final published version in PLoS ONE, Volume 17, Issue 3, March 2022, Article number e0264329.
The published version is available at https://doi.org/10.1371/journal.pone.0264329. Copyright © Mansour et al.