Injured Kidneys Are Viable Candidates for Transplantation

Injured kidneys from deceased donors may be more viable than previously thought, according to a new study.

Researchers at Yale University (New Haven, CT, USA) conducted a multicenter study involving 1,632 patients to determine associations between acute kidney injury (AKI), kidney discard rates, delayed graft function (DGF), and estimated glomerular filtration rate (eGFR) in the short term, as well as six months after transplantation. As they anticipated, the researchers found an association between AKI and organ discard. They also found that injured kidneys were associated with DGF and a need for continued dialysis support in the first week after transplantation.

The study did not find, however, a link between deceased-donor AKI and poor kidney transplant function six months later. They also found significant favorable interaction between donor AKI and DGF, so that six-month eGFR was progressively better for DGF kidneys with increasing donor AKI. In fact, six-month transplant function was worst for those with DGF who had received a donated kidney with no apparent injury. The study was published in the March 2015 issue of the American Journal of Transplantation.

“Though that result seemed counterintuitive, organs acutely injured in the donor might develop ischemic preconditioning, a mechanism that could protect the organs from the effects of subsequent injury,” suggested lead author Isaac Hall, MD. “Another possible explanation is that the successfully transplanted kidneys with AKI were of otherwise higher quality than the rejected kidneys with AKI, though the study did adjust for many important variables like donor age and comorbidity.”

“The waiting list has grown to over 100,000 patients as thousands more people are wait-listed each year than actually receive a transplant, and more than 5,000 people die each year while waiting for a kidney,” added senior author Chirag Parikh, MD. “Even if it only means a few dozen more kidney transplants each year, those are patients who would come off of the waiting list for transplants sooner and have much better survival than continuing on dialysis in hopes of seemingly higher-quality kidney offers, which may never come in time.”

Donated kidneys with AKI are often discarded for fear of poor outcomes, such as delayed function and even premature kidney transplant failure.

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