Research Article: Expanding the donor pool in kidney transplantation: Should organs with acute kidney injury be accepted?—A retrospective study

Date Published: March 13, 2019

Publisher: Public Library of Science

Author(s): Katharina Schütte-Nütgen, Markus Finke, Sabrina Ehlert, Gerold Thölking, Hermann Pavenstädt, Barbara Suwelack, Daniel Palmes, Ralf Bahde, Raphael Koch, Stefan Reuter, Joerg Latus.


Given the gap between patients in need of a renal transplantation (RTx) and organs available, transplantation centers increasingly accept organs of suboptimal quality, e.g. from donors with acute kidney injury (AKI).

To determine the outcome of kidney transplants from deceased donors with AKI (defined as ≥ AKIN stage 1), all 107 patients who received a RTx from donors with AKI between August 2004 and July 2014 at our center were compared to their respective consecutively transplanted patients receiving kidneys from donors without AKI. 5-year patient and graft survival, frequencies of delayed graft function (DGF), acute rejections and glomerular filtration rate (eGFR, CKD-EPI) were assessed.

Patient survival was similar in both groups, whereas death-censored and overall graft survival were decreased in AKI kidney recipients. AKI kidney recipients showed higher frequencies of DGF and had a reduced eGFR at 7 days, three months and one and three years after RTx. However, mortality was noticeably lower compared to waiting list candidates. Rejection-free survival was similar between groups.

In our cohort, both short-term and long-term renal function was inferior in recipients of AKI kidneys, while patient survival was similar. Our data indicates that recipients of donor AKI kidneys should be carefully selected and additional factors impairing short- and long-term outcome should be minimized to prevent further deterioration of graft function.

Partial Text

Renal transplantation (RTx) is the number one choice for treating end-stage renal disease (ESRD) yielding a better prognosis and quality of life compared to dialysis [1,2]. Donor organs are rare, for instance in Germany only 1.497 patients received an organ from a deceased donor in 2016 while 7.876 patients were waiting for a suitable organ on 31st December 2016 [3]. Thus, clinicians are confronted with the question under which conditions an offered donor kidney is responsibly acceptable. The establishment of the so-called rescue allocation led to discard rates for donated kidneys of 7.5% [4].

The gap between organ supply and demand in kidney transplantation has led to different strategies to reasonably enlarge the donor pool.




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