Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea.
Keimyung University Kidney Institute, Daegu, South Korea.
BMC Nephrol. 2019 Feb 4;20(1):39. doi: 10.1186/s12882-019-1225-1.
The problem of organ shortage is an important issue in kidney transplantation, but the effect of kidney donation on AKI is unclear. The aim of this study was to investigate the impact of acute kidney injury (AKI) on post-transplant clinical outcomes for deceased donor kidney transplantation (DDKT) using standard criteria donors (SCDs) versus expanded criteria donors (ECDs).
Five-hundred nine KT recipients receiving kidneys from 386 deceased donors (DDs) were included from three transplant centers. Recipients were classified into the SCD-KT or ECD-KT group according to corresponding DDs and both groups were divided into the AKI-KT or non-AKI-KT subgroups according to AKI in donor. We compared the clinical outcomes among those four groups and investigated the interaction between AKI in donors and ECD on allograft outcome.
The incidence of delayed allograft function was higher when the donors had AKI within SCD-KT and ECD-KT groups. In allograft biopsies within 3 months, chronic change was more significant in the AKI-ECD-KT subgroup than in the non-AKI-ECD-KT subgroup, but it did not differ between AKI-SCD-KT and non-AKI-SCD-KT group. AKI-ECD-KT showed higher risk for death-censored allograft failure than the other three groups and a significant interaction was observed between AKI in donors and ECD on the allograft outcome.
The presence of AKI in ECDs significantly impacted the long-term allograft outcomes of kidney transplant recipients, but it did not in SCDs.
器官短缺是肾移植中的一个重要问题，但肾捐献对急性肾损伤（AKI）的影响尚不清楚。本研究旨在使用标准供体（SCD）与扩展标准供体（ECD）来探讨 AKI 对尸体供肾移植（DDKT）后移植临床结局的影响。
从三个移植中心纳入了 386 例 DD 中 509 例接受肾移植的 KT 受者。根据相应的 DD 将受者分为 SCD-KT 或 ECD-KT 组，并且根据供者中是否存在 AKI 将两组均分为 AKI-KT 或非 AKI-KT 亚组。我们比较了这四个组之间的临床结局，并研究了供者 AKI 与 ECD 对同种异体移植物结局的相互作用。
当 SCD-KT 和 ECD-KT 组中的供者存在 AKI 时，延迟移植物功能的发生率更高。在 3 个月内的同种异体移植活检中，AKI-ECD-KT 亚组的慢性改变比非 AKI-ECD-KT 亚组更明显，但在 AKI-SCD-KT 与非 AKI-SCD-KT 组之间没有差异。AKI-ECD-KT 的死亡风险更高，需要进行移植物失败，与其他三组相比，并且在供者 AKI 与 ECD 对移植物结局之间观察到显著的相互作用。
ECD 中存在 AKI 显著影响肾移植受者的长期移植物结局，但在 SCD 中则不然。
