Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Clin Transplant. 2021 May;35(5):e14279. doi: 10.1111/ctr.14279. Epub 2021 Mar 31.
Kidney transplant (KT) outcomes from high kidney donor profile index (KDPI ≥85%) donors with acute kidney injury (AKI) remain underreported. KT from 172 high KDPI Acute Kidney Injury Network (AKIN) stage 0-1 donors and 76 high KDPI AKIN stage 2-3 donors from a single center were retrospectively assessed. The AKIN 2-3 cohort had more delayed graft function (71% vs. 37%, p < .001). At one year, there were no differences in the estimated glomerular filtration rate (44 ± 17 vs. 46 ± 18, p = .42) or fibrosis on protocol biopsy (ci, p = .85). Donor terminal creatinine (p = .59) and length of delayed graft function (p = .39) did not impact one-year eGFR. There were more primary nonfunction (PNF) events in the high KDPI AKIN 2-3 group (5.3% vs. 0.6%, p = .02). With a median follow-up of 3.8 years, one-year death-censored graft failure was 3.5% for AKIN 0-1 and 14.5% for AKIN 2-3 (HR 2.40, 95% CI 1.24-4.63, p = .01). Although AKIN stage 2-3 high KDPI kidneys had comparable one-year eGFR to AKIN stage 0-1 high KDPI kidneys, there were more PNF occurrences and one-year death-censored graft survival was reduced. Given these findings, additional precautions should be undertaken when assessing and utilizing kidneys from severe AKI high KDPI donors.
高肾捐赠者特征指数（KDPI≥85%）伴有急性肾损伤（AKI）的肾脏移植（KT）结果报告较少。回顾性评估了来自单个中心的 172 名高 KDPI 急性肾损伤网络（AKIN）0-1 期和 76 名高 KDPI AKIN 2-3 期的 AKI 供体。AKIN 2-3 队列的延迟移植物功能障碍（DGF）发生率更高（71% vs. 37%，p<0.001）。1 年后，估算肾小球滤过率（eGFR）（44±17 vs. 46±18，p=0.42）或协议活检纤维化（ci，p=0.85）无差异。供体终末期肌酐（p=0.59）和 DGF 持续时间（p=0.39）不影响 1 年 eGFR。高 KDPI AKIN 2-3 组原发性无功能（PNF）事件更多（5.3% vs. 0.6%，p=0.02）。中位随访 3.8 年后，AKIN 0-1 组和 AKIN 2-3 组的 1 年死亡风险校正移植物失败率分别为 3.5%和 14.5%（HR 2.40，95%CI 1.24-4.63，p=0.01）。尽管 AKIN 2-3 期高 KDPI 肾脏的 1 年 eGFR 与 AKIN 0-1 期高 KDPI 肾脏相当，但 PNF 发生率更高，1 年死亡风险校正移植物存活率降低。鉴于这些发现，在评估和利用严重 AKI 高 KDPI 供体的肾脏时，应采取额外的预防措施。
