Association Between Deceased Donor Acute Kidney Injury Assessed Using Baseline Serum Creatinine Back-Estimation and Graft Survival: Results From the French National CRISTAL Registry.

While deceased donor acute kidney injury (AKI) frequently leads to kidney discards, its impact on long-term graft survival in kidney transplant recipients remains unclear. We investigated the association between deceased donor AKI assessed using back-estimation of baseline serum creatinine (Scr) and graft survival.
Observational cohort study.
Adult patients represented within the French CRISTAL registry who received a single kidney allograft from brain-dead deceased donors between January 2006 and December 2017.
A back-estimated MDRD Study equation-derived Scr baseline value was derived for an assumed glomerular filtration rate at 75 mL/min/1.73 m. A refined classification system for donor AKI was implemented as follows: no AKI, undetermined AKI/chronic kidney disease (CKD), recovery from AKI, and ongoing AKI.
Death-censored graft survival.
Multivariable Cox models using a robust variance estimator for paired kidneys from the same donor.
26,786 recipients were classified as follows: no-AKI (n=19,276); undetermined AKI/CKD (n=1745); recovery from AKI (n=2392); and ongoing AKI (n=3373). We observed 4458 kidney graft losses during a median follow-up of 5.7 years. Compared to no-AKI, deceased donor ongoing AKI was associated with an increased risk of graft failure (HR=1.24, 95%CI: 1.13-1.35). The HRs for graft failure in the undetermined AKI/CKD (HR=1.18, 95%CI: 1.06-1.31) and recovery from AKI (HR=1.18, 95%CI: 1.06-1.31) groups were similar to that observed in the ongoing AKI group. The adverse effect of deceased donor AKI was no longer evident when relying either on the admission or the lowest SCr level throughout the procurement procedure as baseline SCr value.
No measurement of urine output in donors.
Deceased donor ongoing AKI, undetermined AKI/CKD, and recovery from AKI according to back-estimated baseline Scr are associated with decreased graft survival. The definition of baseline Scr as the first value measured on admission would have led to a misclassification bias and erroneous estimates.

Copyright © 2021. Published by Elsevier Inc.