Single kidney transplantation from donors with acute kidney injury: A single-center experience

Introduction: Despite a severe shortage of organ supply, patients are reluctant to accept organs from deceased donors with AKI, let alone from pediatric AKI donors. Methods: We assessed 70 patients who received kidneys from donors with AKI (10 with pediatric and 60 with adult donors) and 176 contemporaneous patients who received kidneys from non-AKI donors (41 with pediatric and 135 with adult donors) between March 2012 and February 2017 for retrospectively evaluating the clinical outcomes. Results: AKI was defined and staging by the RIFLE criteria and pediatric-modified RIFLE criteria. Median age was 11.00 years IQR (4.50-14.00 years), and median weight was 25.00 kg (IQR, 17.00-45.00 kg) for all pediatric donors. Median follow-up was 8 months (range, 1-49 months). Adult AKI group had the highest incidence of DGF (35.0% vs 10%, 9.8%, and 19.3%, P = 0.011). There was a significant increase in DGF in higher AKI stages (Risk: 20.7%, Injury: 46.7%, Failure: 50.0%; P = 0.014) among patients with adult donors. No significant differences were noted in 1-year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) and 3-year (100.0%, 95.1%, 98.3%, and 97.8%; P = 0.751) patient survival, and 1-year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) and 3-year (90.0%, 97.6%, 98.3%, and 95.6%; P = 0.535) graft survival. Conclusion: Transplants procured from donors with AKI, particularly pediatric ones, could achieve excellent intermediate-term clinical outcomes and thus potentially expand the donor pool.