Transplantation of Kidneys from Donors with Acute Renal Failure Five-Year Results from Double Center Experience

Authors

Ahmad Safra, MD, Thomas Jefferson UniversityFollow
Ashesh P. Shah, MD, Thomas Jefferson UniversityFollow
Cataldo Doria, MD, PhD, Jefferson Medical College - Thomas Jefferson University HospitalFollow
Warren R Maley, MD, Thomas Jefferson UniversityFollow
Adam M. Frank, MD, Thomas Jefferson UniversityFollow
Chad Gorn, Thomas Jefferson UniversityFollow
Laurel Lerner, RN, Lankenau Medical Center, Wynnewood PA
Marie Manley, Lankenau Medical Center, Wynnewood PA
Carlo B Ramirez, MD, Department of Surgery, Thomas Jefferson UniversityFollow

Document Type

Poster

Publication Date

5-2-2015

Comments

Poster presented at: American Transplant Congress in Philadelphia, PA on May 2-6, 2015

Abstract

Background:

Transplantation of kidneys from deceased donors with acute renal failure (ARF) has been described and represents an underutilized source of renal grafts. We reviewed retrospectively our double center experience with transplantation of ARF donor kidneys.

Methods:

Between January 2009 and June 2014, we performed a total of 397 kidney transplants at the two hospitals. Of which, 65 came from donors with ARF. The outcome was compared with 62 expanded criteria donor kidneys and 270 standard criteria donor kidneys. ARF was defined as donor terminal creatinine higher than 2. All kidneys from ARF donors had acceptable biopsies and were pumped. The immunosuppression was similar in all three groups (Thymoglobulin for induction and Prograf, Cellcept and steroids for maintenance). The outcome measurements included recipient serum creatinine, patient and graft survival at 6 months, 1 year and 3 years. We also reviewed the delayed graft function (DGF) rates and cold ischemic time in all groups.

Results:

Mean donor creatinine was 3.84±1.3. The 6 month, 1 and 3 year patient survival rates were 98.5%, 96.8% and 92.0% in ARF group, 98.1%, 97.0% and 93.4% SCD group and 98.4%, 93.2% and 77.7% in ECD group. The 6 month, 1 and 3 year death censored graft survival was 96.9%, 96.9%, 96.9% in ARF group, 97.7, 96.5, 91.8 in SCD group and 95.1%, 93.2%, 90.1% in ECD group. The mean 6mo, 1 year and 3 year recipient creatinine was 1.49, 1.46 and 1.51 in ARF group, 1.61, 1.72 and 1.77 in SCD group and 1.91, 1.92 and 2.15 in ECD group, respectively. ARF kidneys are noted to be associated with more DGF (58.5% in ARF group VS 41.5% in non ARF group), longer cold ischemic time (857.79 min in ARF group vs 589.32 min in non ARF group) and younger donor age (32.25 years in ARF group vs 40.65 years in non ARF group).

Conclusion:

Elevated terminal donor creatinine is not a risk factor for graft loss after deceased donor kidney transplantation. Although there is increased risk of DGF and longer cold ischemic time, transplantation of ARF kidneys provides comparable short and long term graft function and patient survival compared to kidneys from non ARF donors.

Recommended Citation

Safra, MD, Ahmad; Shah, MD, Ashesh P.; Doria, MD, PhD, Cataldo; Maley, MD, Warren R; Frank, MD, Adam M.; Gorn, Chad; Lerner, RN, Laurel; Manley, Marie; and Ramirez, MD, Carlo B, "Transplantation of Kidneys from Donors with Acute Renal Failure Five-Year Results from Double Center Experience" (2015). Department of Surgery Faculty Papers. Paper 121.
https://jdc.jefferson.edu/surgeryfp/121