Decision Making by Young Transplant Surgeons Regarding Expanded-Criteria Donors With Acute Kidney Injury or...

Area of Science:

• Nephrology
• Transplantation Surgery
• Organ Donation

Background:

• Expanded-criteria donors (ECDs) are increasingly utilized to address organ shortages.
• Acute kidney injury (AKI) in ECDs leads to higher discard rates.
• Evaluating transplant outcomes in ECDs and standard-criteria donors (SCDs) with and without AKI is crucial.

Purpose of the Study:

• To assess the outcomes of kidney transplantation using expanded-criteria donors (ECDs) with and without acute kidney injury (AKI).
• To compare these outcomes with those from standard-criteria donors (SCDs) with and without AKI.
• To provide guidance on the utilization of ECDs with AKI in kidney transplantation.

Main Methods:

• Retrospective review of medical records for kidney transplant recipients.
• Application of the Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition.
• Analysis of donor and recipient demographics and transplantation outcomes.

Main Results:

• No significant differences in initial creatinine or estimated glomerular filtration rate (eGFR) between donor groups.
• Highest incidence of delayed graft function observed in ECDs with AKI (36.4%), though not statistically significant.
• No significant differences in last recorded creatinine or eGFR across all donor groups (ECDs with/without AKI, SCDs with/without AKI).

Conclusions:

• ECDs with AKI can be considered for kidney transplantation, particularly if initial creatinine levels are normal.
• Dual-kidney transplantation may be a viable option for utilizing ECDs with AKI.
• Surgeons should not hesitate to use ECDs with AKI, given the lack of consensus on discard criteria and comparable outcomes.