Outcomes of Kidney Transplant When Deceased Donor Received Dialysis

Kidneys from deceased donors with acute kidney injury (AKI) are often discarded. Up to 44% of kidneys from deceased donors with stage 3 AKI are not transplanted. However, recent evidence suggests that transplanting kidneys from certain donors with AKI has a risk of graft failure comparable with kidneys from deceased donors without AKI. Research is lacking, as previous studies have not included deceased donors with the most severe AKI and those who received dialysis. 

Researchers, including Yumeng Wen, MD, PhD, studied whether kidneys transplanted from deceased donors who received dialysis prior to donation were associated with worse outcomes in kidney recipients versus kidneys from deceased donors who did not have dialysis. Their findings were published in JAMA. 

Using data from the Organ Procurement and Transplantation Network, the researchers analyzed 1944 kidney transplant recipients. They identified 805 deceased donors aged 16 years or older from 2010 to 2018 who received dialysis prior to kidney donation. These were matched 1:1 with donors who did not undergo dialysis using a rank-based distance matrix algorithm. Of the 1944 transplant recipients studied, 954 received kidneys from deceased donors who had dialysis.  

The short-term study outcome was delayed graft function (DGF; defined as receipt of dialysis by the kidney recipient within 1 week after kidney transplant). Longer-term outcomes were all-cause graft failure (a composite of death and graft failure), death-censored graft failure, death, estimated glomerular filtration rate (eGFR) at 6 months and 12 months post-transplant, and longitudinal decline in eGFR. 

Kidney transplants from donors who received dialysis prior to donation (n=954 kidney recipients) were associated with a higher risk of delayed graft function versus kidney transplants from donors who did not receive dialysis (n=990 kidney recipients; 59.2% vs 24.6%, respectively; adjusted odds ratio, 4.17 [95% CI, 3.28-5.29]).  

However, at a longer-term follow-up (34.1 months), incidence rates did not significantly differ for all-cause graft failure (43.1 kidney transplants per 1000 person-years from donors who received dialysis prior to donation vs 46.9 kidney transplants per 1000 person-years from donors who did not receive dialysis; adjusted hazard ratio [HR], 0.90 [95% CI, 0.70-1.15]). Incidence rates at 34.1 months also did not differ significantly for death-censored graft failure (22.5 vs 20.6 per 1000 person-years, respectively; adjusted HR, 1.18 [95% CI, 0.83-1.69]) or death (24.6 vs 30.8 per 1000 person-years; adjusted HR, 0.76 [95% CI, 0.55-1.04]). 

The authors acknowledged the limitations of their study. Because its design was retrospective, the study was subject to confounding and selection bias. The number of deceased donors who had dialysis was small, particularly among Black individuals. Demographic information on donors such as race, recipient comorbidities, and changes in immunosuppression over time was lacking. 

In sum, the authors wrote, “Compared with receiving a kidney from a deceased donor who did not undergo dialysis, receiving a kidney from a deceased donor who underwent dialysis prior to kidney donation was associated with a significantly higher incidence of DGF, but no significant difference in graft failure or death at follow-up.”

Source: JAMA