Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea.
Clin Transplant. 2018 Dec;32(12):e13431. doi: 10.1111/ctr.13431. Epub 2018 Nov 22.
Deceased donor kidneys (DDKs) with acute kidney injury (AKI) are difficult to allocate for fear of the expected graft outcome. We aimed to evaluate the impact of donors' AKI severity and trend on graft outcomes in DDK transplantation. This was a retrospective study of DDK transplantation performed from 2005 to 2014. Based on maximum and terminal serum creatinine values before transplantation, the AKI trends were categorized as improving or worsening. Of 413 DDKs, 275 developed AKI: 177 stage 1, 52 stage 2, and 46 stage 3. DDKs with AKI had 212 improving AKI and 63 worsening AKI. Graft outcomes were similar based on AKI stage. Worsening AKI did not affect delayed graft function development; however, it significantly elevated graft failure risk even after adjusting for AKI stage and Kidney Donor Risk Index. Graft survival of the improving group was similar to DDKs with no AKI. This study showed that AKI severity of DDKs did not affect overall graft outcomes. Notably, DDKs with improving AKI showed a similar graft survival rate to DDKs without AKI, although worsening AKI had a worse prognosis. Consideration of the AKI trend, rather than its severity, is needed when DDKs with AKI are allocated.
供体发生急性肾损伤（AKI）的死亡供肾（DDK）由于担心预期移植物的结果而难以分配。我们旨在评估供体 AKI 严重程度和趋势对 DDK 移植中移植物结局的影响。这是一项对 2005 年至 2014 年进行的 DDK 移植的回顾性研究。根据移植前最大和终末期血清肌酐值，将 AKI 趋势分为改善或恶化。在 413 例 DDK 中，275 例发生 AKI：177 例 1 期，52 例 2 期，46 例 3 期。发生 AKI 的 DDK 中，212 例 AKI 改善，63 例 AKI 恶化。根据 AKI 分期，移植物结局相似。AKI 恶化并不影响延迟移植物功能的发展；然而，即使在调整 AKI 分期和肾脏供体风险指数后，它也显著增加了移植物衰竭的风险。改善组的移植物存活率与无 AKI 的 DDK 相似。本研究表明，DDK 的 AKI 严重程度不影响整体移植物结局。值得注意的是，尽管 AKI 恶化的预后较差，但 AKI 改善的 DDK 的移植物存活率与无 AKI 的 DDK 相似。在分配发生 AKI 的 DDK 时，需要考虑 AKI 趋势，而不仅仅是其严重程度。
