Icahn School of Medicine at Mount Sinai, New York, New York.
Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Transplant. 2022 Mar;22(3):898-908. doi: 10.1111/ajt.16920. Epub 2021 Dec 22.
Kidney allocation trends from deceased donors with acute kidney injury (AKI) have not been characterized since initial Kidney Donor Profile Index reporting in 2012 and its use under the revised Kidney Allocation System (KAS) in 2014. We conducted a retrospective analysis of US registry data to characterize kidney procurement and discard trends in deceased donors with AKI, defined by ≥50% or ≥0.3 mg/dl (≥4.0 mg/dl or ≥200% for stage 3) increase in terminal serum creatinine from admission. From 2010 to 2020, 172 410 kidneys were procured from 93 341 deceased donors 16 years or older; 34 984 kidneys were discarded (17 559 from AKI donors). The proportion of stage 3 AKI donors doubled from 6% (412/6841) in 2010 to 12% (1365/11493) in 2020. Procurement of stage 3 AKI kidneys increased from 51% (423/824) to 80% (2183/2730). While discard of stage 3 AKI kidneys increased from 41% (175/423) in 2010 to 44% (960/2183) in 2020, this increase was not statistically significant in interrupted time-series analysis following KAS implementation (slope difference -0.41 [-3.22, 2.4], and level change 3.09 [-6.4, 12.6]). In conclusion, the absolute number of stage 3 AKI kidneys transplanted has increased. Ongoing high discard rates of these kidneys suggest opportunities for improved utilization.
自 2012 年首次报告肾脏捐赠者概况指数（KDPI）以来，以及 2014 年修订后的肾脏分配系统（KAS）开始使用以来，急性肾损伤（AKI）的已故供体的肾脏分配趋势尚未得到描述。我们对美国登记处的数据进行了回顾性分析，以描述 AKI 已故供体的肾脏获取和丢弃趋势，AKI 的定义为入院时终末期血清肌酐升高≥50%或≥0.3mg/dL（3 期为≥4.0mg/dL 或≥200%）。2010 年至 2020 年，从 93341 名 16 岁或以上的已故供体中获取了 172410 个肾脏；丢弃了 34984 个肾脏（17559 个来自 AKI 供体）。3 期 AKI 供体的比例从 2010 年的 6%（412/6841）增加到 2020 年的 12%（1365/11493）。3 期 AKI 肾脏的获取量从 51%（423/824）增加到 80%（2183/2730）。虽然 3 期 AKI 肾脏的丢弃量从 2010 年的 41%（175/423）增加到 2020 年的 44%（960/2183），但在 KAS 实施后的中断时间序列分析中，这种增加没有统计学意义（斜率差异-0.41[-3.22，2.4]，水平变化 3.09[-6.4，12.6]）。总之，移植的 3 期 AKI 肾脏数量绝对增加。这些肾脏的高丢弃率表明有机会提高利用率。
