Department of Nephrology, Xiamen University and Fujian Medical University Affiliated First Hospital, Xiamen, China.
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
PLoS One. 2021 Mar 25;16(3):e0249000. doi: 10.1371/journal.pone.0249000. eCollection 2021.
The need for kidney transplantation drives efforts to expand organ donation. The decision to accept organs from donors with acute kidney injury (AKI) can result in a clinical dilemma in the context of conflicting reports from published literature.
This observational study included all deceased donor kidney transplants performed in Australia and New Zealand between 1997 and 2017. The association of donor-AKI, defined according to KDIGO criteria, with all-cause graft failure was evaluated by multivariable Cox regression. Secondary outcomes included death-censored graft failure, death, delayed graft function (DGF) and acute rejection.
The study included 10,101 recipients of kidneys from 5,774 deceased donors, of whom 1182 (12%) recipients received kidneys from 662 (11%) donors with AKI. There were 3,259 (32%) all-cause graft failures, which included 1,509 deaths with functioning graft. After adjustment for donor, recipient and transplant characteristics, donor AKI was not associated with all-cause graft failure (adjusted hazard ratio [HR] 1.11, 95% CI 0.99-1.26), death-censored graft failure (HR 1.09, 95% CI 0.92-1.28), death (HR 1.15, 95% CI 0.98-1.35) or graft failure when death was evaluated as a competing event (sub-distribution hazard ratio [sHR] 1.07, 95% CI 0.91-1.26). Donor AKI was not associated with acute rejection but was associated with DGF (adjusted odds ratio [OR] 2.27, 95% CI 1.92-2.68).
Donor AKI stage was not associated with any kidney transplant outcome, except DGF. Use of kidneys with AKI for transplantation appears to be justified.
肾脏移植的需求推动了扩大器官捐献的努力。在有冲突的文献报道的情况下，接受急性肾损伤（AKI）供体器官的决定可能会导致临床困境。
本观察性研究纳入了 1997 年至 2017 年间在澳大利亚和新西兰进行的所有已故供体肾移植。根据 KDIGO 标准定义的供体 AKI 与全因移植物失败的关系，通过多变量 Cox 回归进行评估。次要结局包括死亡相关移植物失败、死亡、延迟移植物功能（DGF）和急性排斥反应。
该研究纳入了 10101 例接受 5774 例已故供体肾脏的受者，其中 1182 例（12%）受者接受了 662 例（11%）AKI 供者的肾脏。共有 3259 例（32%）发生全因移植物失败，其中 1509 例死亡并保留有功能的移植物。在调整供体、受者和移植特征后，供体 AKI 与全因移植物失败（调整后的危险比 [HR]1.11，95%CI0.99-1.26）、死亡相关移植物失败（HR1.09，95%CI0.92-1.28）、死亡（HR1.15，95%CI0.98-1.35）或在将死亡视为竞争事件时的移植物失败（亚分布危险比 [sHR]1.07，95%CI0.91-1.26）无关。供体 AKI 与急性排斥反应无关，但与 DGF 有关（调整后的优势比 [OR]2.27，95%CI1.92-2.68）。
除 DGF 外，供体 AKI 分期与任何肾脏移植结局无关。使用 AKI 供体肾脏进行移植似乎是合理的。
