Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury

Wang Hongyu; Wang Hong; Shen Songying; Zhao He; Qin Xingsong; Qin Wei; Qian Xinling; Dong Huijun; Zhao Yunfeng; Wang Yafang; Li Peiliang

doi:10.3969/j.issn.1674-7445.2024027

Volume 15 Issue 4

Jul. 2024

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Wang Hongyu, Wang Hong, Shen Songying, et al. Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury[J]. ORGAN TRANSPLANTATION, 2024, 15(4): 622-629. doi: 10.3969/j.issn.1674-7445.2024027

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Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury

doi: 10.3969/j.issn.1674-7445.2024027

1.
The Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou 450003, China

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Corresponding author: Li Peiliang, Email: 156863001@qq.com
Received Date: 2024-02-18
Publish Date: 2024-07-15

Abstract

Abstract

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death (DBD) donors complicated with acute kidney injury (AKI). Methods Clinical data of 216 DBD donors were retrospectively analyzed, and they were divided into the AKI group (n=69) and control group (n=147) according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups. One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group. Postoperative recovery of renal function and clinical outcomes of the recipients were recorded. The risk factors of delayed graft function (DGF) were identified. Results The highest serum creatinine (Scr) level, Scr level before procurement, the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group. The application duration of vasopressors in the AKI group was longer than that in the control group. In the AKI group, the amount of fluid resuscitation within 48 h was higher, the HCO₃⁻ level at admission was lower, and the incidence of diabetes insipidus and hypotension was higher than those in the control group. The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts (all P<0.05). Compared with the control group, the incidence of DGF and acute rejection was higher, the proportion of continuous renal replacement therapy was higher, the Scr level within postoperative 90 d was higher, and the urine amount within postoperative 3 d was less than those of recipients in the AKI group. Compared with KDIGO stage 1 recipients, KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3, 4, 5 and 15 d, and less urine amount at postoperative 2 d (all P<0.05). Univariate analysis showed that donor age, the highest Scr level, the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation. Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation (all P<0.05). Conclusions For the application of DBD donors complicated with AKI, active organ maintenance should be performed to alleviate AKI. It exerts no effect upon graft function and survival rate at postoperative 6 months, which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.
- Acute kidney injury,
- Brain death,
- Organ donation,
- Kidney transplantation,
- Marginal donor,
- Organ maintenance,
- Delayed graft function,
- Primary nonfunction

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References

[1]	TANNOUS LA, WESTPHAL GA, IOSHII SO, et al. Histological, laboratorial, and clinical benefits of an optimized maintenance strategy of a potential organ donor-a rabbit experimental model[J]. Life (Basel), 2023, 13(7): 1439. DOI: 10.3390/life13071439.
[2]	谢良波, 夏秋翔, 曾宪鹏, 等. 《移植器官质量与安全指南(第6版)》解读——供者及器官的评估和选择标准[J]. 器官移植, 2020, 11(4): 487-491. DOI: 10.3969/j.issn.1674-7445.2020.04.011. XIE LB, XIA QX, ZENG XP, et al. Interpretation of Guide to the Quality and Safety of Organs for Transplantation (6th edition): evaluation and selection criteria for donors and organs[J]. Organ Transplantation, 2020, 11(4): 487-491. DOI: 10.3969/j.issn.1674-7445.2020.04.011.
[3]	NITA GE, GOPAL JP, KHAMBALIA HA, et al. Kidney transplantation from donors with acute kidney injury: are the concerns justified? a systematic review and meta-analysis[J]. Transpl Int, 2023, 36: 11232. DOI: 10.3389/ti.2023.11232.
[4]	国家卫生健康委员会脑损伤质控评价中心, 中华医学会神经病学分会神经重症协作组, 中国医师协会神经内科医师分会神经重症专业委员会. 中国成人脑死亡判定标准与操作规范(第二版)[J]. 中华医学杂志, 2019, 99(17): 1288-1292. DOI: 10.3760/cma.j.issn.0376-2491.2019.17.003. Brain Injury Evaluation Quality Control Center of National Health and Family Planning Commission, Neurology Critical Care Cooperative Group of Neurology Branch of Chinese Medical Association, Neurology Critical Care Professional Committee of Neurology Physicians Branch of Chinese Medical Doctor Association. Criteria and practical specification for determination of brain death in adults (2nd edition)[J]. Natl Med J China, 2019, 99(17): 1288-1292. DOI: 10.3760/cma.j.issn.0376-2491.2019.17.003.
[5]	CHAWLA LS, BELLOMO R, BIHORAC A, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup[J]. Nat Rev Nephrol, 2017, 13(4): 241-257. DOI: 10.1038/nrneph.2017.2.
[6]	KELLUM JA, LAMEIRE N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1)[J]. Crit Care, 2013, 17(1): 204. DOI: 10.1186/cc11454.
[7]	SONNENBERG EM, HSU JY, COHEN JB, et al. Acute kidney injury in deceased organ donors and kidney transplant outcomes: a national cohort study using a novel data source[J]. Ann Surg, 2022, 276(6): e982-e990. DOI: 10.1097/SLA.0000000000004597.
[8]	王会龙, 阮东丽, 刘克普, 等. 扩大标准肾移植术后临床效果分析和器官维护策略探讨[J/OL]. 实用器官移植电子杂志, 2023, 11(2): 128-133. DOI: 10.3969/j.issn.2095-5332.2023.02.007. WANG HL, RUAN DL, LIU KP, et al. Clinical effect analysis and organ maintenance strategy investigation for expanded standard DCD renatransplantation[J/OL]. Pract J Organ Transplant (Electr Vers), 2023, 11(2): 128-133. DOI: 10.3969/j.issn.2095-5332.2023.02.007.
[9]	ANDERSON DJ, LOCKE JE. Progress towards solving the donor organ shortage[J]. Nat Rev Nephrol, 2023, 19(2): 83-84. DOI: 10.1038/s41581-022-00664-y.
[10]	XU H, HE X. Developments in kidney xenotransplantation[J]. Front Immunol, 2024, 14: 1242478. DOI: 10.3389/fimmu.2023.1242478.
[11]	赵婕, 霍枫, 赵洪涛, 等. 系统性多科室协作器官捐献国际经验对我国的启示[J]. 器官移植, 2022, 13(6): 683-689. DOI: 10.3969/j.issn.1674-7445.2022.06.001. ZHAO J, HUO F, ZHAO HT, et al. Enlightenment of international experience of organ donation related systematic multi-department collaboration to China[J]. Organ Transplant, 2022, 13(6): 683-689. DOI: 10.3969/j.issn.1674-7445.2022.06.001.
[12]	HE W, WU Y, GONG C, et al. Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors[J]. Quant Imaging Med Surg, 2023, 13(9): 6014-6025. DOI: 10.21037/qims-23-207.
[13]	WEBB CJ, MCCRACKEN E, JAY CL, et al. Single center experience and literature review of kidney transplantation from non-ideal donors with acute kidney injury: risk and reward[J]. Clin Transplant, 2023, 37(10): e15115. DOI: 10.1111/ctr.15115.
[14]	SRIVASTAVA V, NAKRA M, SHANKAR KA, et al. Optimal management of brain-dead organ donor[J]. Med J Armed Forces India, 2021, 77(1): 1-5. DOI: 10.1016/j.mjafi.2020.01.010.
[15]	YOUSIF ZK, KOOLA JD, MACEDO E, et al. Clinical characteristics and outcomes of drug-induced acute kidney injury cases[J]. Kidney Int Rep, 2023, 8(11): 2333-2344. DOI: 10.1016/j.ekir.2023.07.037.
[16]	LIU Q, ZHANG H, ZHONG M, et al. Excellent clinical outcomes of renal transplant from pediatric deceased donors with acute kidney injury[J]. Eur J Med Res, 2023, 28(1): 161. DOI: 10.1186/s40001-023-01111-9.
[17]	FIORENTINO M, BAGAGLI F, DELEONARDIS A, et al. Acute kidney injury in kidney transplant patients in intensive care unit: from pathogenesis to clinical management[J]. Biomedicines, 2023, 11(5): 1474. DOI: 10.3390/biomedicines11051474.
[18]	LEE MH, JEONG EG, CHANG JY, et al. Clinical outcome of kidney transplantation from deceased donors with acute kidney injury by Acute Kidney Injury Network criteria[J]. J Crit Care, 2014, 29(3): 432-437. DOI: 10.1016/j.jcrc.2013.12.016.
[19]	KIM KD, LEE KW, KIM SJ, et al. Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study[J]. Sci Rep, 2021, 11(1): 5572. DOI: 10.1038/s41598-021-84977-1.
[20]	王红宇, 焦宪法, 牛杏果, 等. 伴急性肾损伤的脑死亡器官捐献供者供肾移植治疗的体会[J]. 器官移植, 2017, 8(6): 424-429. DOI: 10.3969/j.issn.1674-7445.2017.06.003. WANG HY, JIAO XF, NIU XG, et al. Experience of clinical efficacy of renal transplantation from donors of donation after brain death complicated with acute kidney injury[J]. Organ Transplant, 2017, 8(6): 424-429. DOI: 10.3969/j.issn.1674-7445.2017.06.003.
[21]	WESTPHAL GA, COLL E, DE SOUZA RL, et al. Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance[J]. Crit Care, 2016, 20(1): 323. DOI: 10.1186/s13054-016-1484-1.
[22]	王红宇, 曲青山, 梁韶峰, 等. 自发性脑出血致脑死亡器官捐献供体脏器功能维护71例总结[J]. 国际医药卫生导报, 2018, 24(21): 3246-3247. DOI: 10.3760/cma.j.issn.1007-1245.2018.21.009. WANG HY, QU QS, LIANG SF, et al. Maintenance of 71 brain dead organ donation donors caused by spontaneous cerebral hemorrhage[J]. Inter Med Health Guid New, 2018, 24(21): 3246-3247. DOI: 10.3760/cma.j.issn.1007-1245.2018.21.009.
[23]	WESTPHAL GA, ROBINSON CC, GIORDANI NE, et al. Evidence-based checklist to delay cardiac arrest in brain-dead potential organ donors: the DONORS cluster randomized clinical trial[J]. JAMA Netw Open, 2023, 6(12): e2346901. DOI: 10.1001/jamanetworkopen.2023.46901.
[24]	李爽, 包宇实. 缺血再灌注急性肾损伤机制研究进展[J]. 医学综述, 2020, 26(19): 3848-3853. DOI: 10.3969/j.issn.1006-2084.2020.19.020. LI S, BAO YS. Research progress in mechanisms of acute renal injury induced by ischemia-reperfusion injury[J]. Med Recap, 2020, 26(19): 3848-3853. DOI: 10.3969/j.issn.1006-2084.2020.19.020.
[25]	PUNUKOLLU R, RYAN M, MISRA S, et al. Past, current, and future perspectives on transplanting acute kidney injury kidneys[J]. Clin Pract, 2023, 13(4): 944-958. DOI: 10.3390/clinpract13040086.
[26]	DUARTE TTP, MAGRO MCS. Recovery of renal function in clinical patients with acute kidney injury: impact on mortality[J]. Life (Basel), 2022, 12(6): 852. DOI: 10.3390/life12060852.
[27]	WANG D, GUO Y, ZHANG Y, et al. Epidemiology of acute kidney injury in patients with stroke: a retrospective analysis from the neurology ICU[J]. Intern Emerg Med, 2018, 13(1): 17-25. DOI: 10.1007/s11739-017-1703-z.
[28]	HOUNKPATIN HO, FRASER SDS, GLIDEWELL L, et al. Predicting risk of recurrent acute kidney injury: a systematic review[J]. Nephron, 2019, 142(2): 83-90. DOI: 10.1159/000497385.
[29]	GARNER M, JAY CL, SHARDA B, et al. Long-term outcomes of kidney transplantation from deceased donors with terminal acute kidney injury: single center experience and literature review[J]. Clin Transplant, 2023, 37(3): e14886. DOI: 10.1111/ctr.14886.
[30]	PALMISANO A, GANDOLFINI I, DELSANTE M, et al. Acute kidney injury (AKI) before and after kidney transplantation: causes, medical approach, and implications for the long-term outcomes[J]. J Clin Med, 2021, 10(7): 1484. DOI: 10.3390/jcm10071484.
[31]	YAQUB S, HASHMI S, KAZMI MK, et al. A comparison of AKIN, KDIGO, and RIFLE definitions to diagnose acute kidney injury and predict the outcomes after cardiac surgery in a South Asian cohort[J]. Cardiorenal Med, 2022, 12(1): 29-38. DOI: 10.1159/000523828.
[32]	GOYAL A, DANESHPAJOUHNEJAD P, HASHMI MF, et al. Acute kidney injury[M]. Treasure Island (FL): StatPearls Publishing, 2024.
[33]	HAMZIC-MEHMEDBASIC A, MACKIC M, REBIC D, et al. Acute kidney injury classifications in the prediction of in-hospital mortality and renal function non-recovery[J]. Mater Sociomed, 2023, 35(4): 304-308. DOI: 10.5455/msm.2023.35.304-308.
[34]	KIM JH, KIM YS, CHOI MS, et al. Prediction of clinical outcomes after kidney transplantation from deceased donors with acute kidney injury: a comparison of the KDIGO and AKIN criteria[J]. BMC Nephrol, 2017, 18(1): 39. DOI: 10.1186/s12882-017-0461-5.
[35]	刘洵, 薛梅, 吴安石. RIFLE、AKIN和KDIGO标准预测肝移植术后早期死亡的准确性比较[J]. 器官移植, 2020, 11(3): 369-373,390. DOI: 10.3969/j.issn.1674-7445.2020.03.008. LIU X, XUE M, WU AS. Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation[J]. Organ Transplant, 2020, 11(3): 369-373,390. DOI: 10.3969/j.issn.1674-7445.2020.03.008.
[36]	陈佳弘, 徐莹, 何松哲, 等. 肝移植术后早期急性肾损伤的危险因素分析[J]. 中华器官移植杂志, 2023, 44(5): 269-274. DOI: 10.3760/cma.j.cn421203-20221230-00343. CHEN JH, XU Y, HE SZ, et al. Risk factors for early acute kidney injury after classic orthotopic liver transplantation[J]. Chin J Organ Transplant, 2023, 44(5): 269-274. DOI: 10.3760/cma.j.cn421203-20221230-00343.
[37]	KOYAWALA N, PARIKH CR. A review of donor acute kidney injury and posttransplant outcomes[J]. Transplantation, 2020, 104(8): 1553-1559. DOI: 10.1097/TP.0000000000003144.
[38]	LIU C, ALASFAR S, REESE PP, et al. Trends in the procurement and discard of kidneys from deceased donors with acute kidney injury[J]. Am J Transplant, 2022, 22(3): 898-908. DOI: 10.1111/ajt.16920.

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Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury

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Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury

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