Deceased-donor acute kidney injury is not associated with kidney allograft failure

Kidney Int. 2019 Jan;95(1):199-209. doi: 10.1016/j.kint.2018.08.047. Epub 2018 Nov 20.


Deceased-donor acute kidney injury (AKI) is associated with organ discard and delayed graft function, but data on longer-term allograft survival are limited. We performed a multicenter study to determine associations between donor AKI (from none to severe based on AKI Network stages) and all-cause graft failure, adjusting for donor, transplant, and recipient factors. We examined whether any of the following factors modified the relationship between donor AKI and graft survival: kidney donor profile index, cold ischemia time, donation after cardiac death, expanded-criteria donation, kidney machine perfusion, donor-recipient gender combinations, or delayed graft function. We also evaluated the association between donor AKI and a 3-year composite outcome of all-cause graft failure or estimated glomerular filtration rate ≤ 20 mL/min/1.73 m2 in a subcohort of 30% of recipients. Among 2,430 kidneys transplanted from 1,298 deceased donors, 585 (24%) were from donors with AKI. Over a median follow-up of 4.0 years, there were no significant differences in graft survival by donor AKI stage. We found no evidence that pre-specified variables modified the effect of donor AKI on graft survival. In the subcohort, donor AKI was not associated with the 3-year composite outcome. Donor AKI was not associated with graft failure in this well-phenotyped cohort. Given the organ shortage, the transplant community should consider measures to increase utilization of kidneys from deceased donors with AKI.

Keywords: acute kidney injury; chronic allograft nephropathy; delayed graft function.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Kidney Injury / physiopathology*
  • Adult
  • Aged
  • Allografts / physiopathology
  • Allografts / supply & distribution
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate / physiology
  • Graft Rejection / epidemiology*
  • Graft Rejection / physiopathology
  • Graft Survival
  • Humans
  • Kidney / physiopathology
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / methods
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Time Factors
  • Tissue Donors
  • Tissue and Organ Procurement / methods
  • Tissue and Organ Procurement / standards*
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / methods
  • Treatment Outcome