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Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

  • Nephrology - Original Paper
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Abstract

Background

Whether organs from donors after brain death (DBD) with acute kidney injury (AKI) should be accepted for transplantation is still a matter of debate.

Methods

This was a retrospective, center-based, matched cohort study of 33 renal transplant patients who received a renal allograft from a DBD with AKI. Sixty-five kidney transplants without donor AKI transplanted directly before and after the index transplantation served as controls.

Results

All AKI donors were classified according to RIFLE criteria: 9.1 % Risk, 54.6 % Injury, and 36.4 % Failure. Mean serum creatinine was 2.41 ± 0.88 mg/dL at procurement and 1.06 ± 0.32 mg/dL on admission. AKI donors had lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009) and received more frequently noradrenaline (93.9 vs. 72.3 %, p = 0.02) and/or adrenaline (15.2 vs. 1.5 %, p = 0.02). Recipient and transplant characteristics were similar except a more favorable HLA match in control patients (p = 0.01). Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 [27.7 %], p = 0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14. One-year graft survival was very similar when comparing the groups (93.6 % [95 % CI 76.8–98.4 %] vs. 90.3 % [95 % CI 79.6–95.5 %], log rank p = 0.58).

Conclusions

Kidneys from AKI donors can be transplanted with excellent intermediate prognosis and should not be discarded.

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Acknowledgments

The results of the present study have been reported in abstract form at the 2012 TTS meeting (Benck U, et al. Excellent intermediate-term results after renal transplantation from brain-dead donors with acute kidney injury, Transplantation 94, 2366, 2012).

Author contributions

The present research has been designed by U.B., P.S., R.B., and B.K.K., statistical analysis has been done by U.B., P.S., and W.H.S., and the first draft of the paper has been prepared by B.K.K. All authors contributed to the conception/design of the work, to acquisition of data and/or analysis of data, to interpretation of data, and to writing or revising of the work, provided important intellectual content, finally approved and are accountable for the work.

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Authors and Affiliations

  1. Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Urs Benck, Peter Schnuelle, Bernd Krüger, Heiko Mundt, Niklas Lutz, Matthias Jung, Rainer Birck, Bernhard K. Krämer & Wilhelm H. Schmitt

  2. Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Urs Benck, Peter Schnuelle, Bernd Krüger, Kai Nowak, Thomas Riester, Heiko Mundt, Niklas Lutz, Matthias Jung, Rainer Birck, Bernhard K. Krämer & Wilhelm H. Schmitt

  3. Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Mannheim, Germany

    Kai Nowak & Thomas Riester

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  1. Urs Benck
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  2. Peter Schnuelle
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  3. Bernd Krüger
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  7. Niklas Lutz
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  8. Matthias Jung
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  9. Rainer Birck
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  10. Bernhard K. Krämer
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  11. Wilhelm H. Schmitt
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Corresponding authors

Correspondence to Urs Benck or Bernhard K. Krämer.

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All authors declare no conflict of interest with regard to the present manuscript.

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Benck, U., Schnuelle, P., Krüger, B. et al. Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study. Int Urol Nephrol 47, 2039–2046 (2015). https://doi.org/10.1007/s11255-015-1127-5

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  • DOI: https://doi.org/10.1007/s11255-015-1127-5

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