John Black

Aims: Acute Kidney Injury (AKI) is defined as an abrupt reduction in kidney function, measured through an increase in serum creatinine and/or decreased urine output. This study looks at kidney donation in the context of donor AKI, with a particular focus on recipient outcomes (graft function, transplant rejection, and mortality). Methods: 23 recipients of kidney transplant from a donor with AKI (stages 1-3) were identified over a 24 month period (01/06/15-01/06/17). 16 recipients were included in this study; 7 were not included based on exclusion criteria. Donor forms were used to obtain donor specifics, and local electronic records were used to assess recipient outcomes. Results: Salient donor details and recipient outcomes from our study are summarised in the table below. The mean average (+/- SD) is used unless otherwise specified.tDONOR DETAILStRECIPIENT OUTCOMESAge (years)t51.9tAge (years)t51.3Sex (M:F)t1:1tPrimary Non-Function (PNF)t0%BMIt27.1(+/- 4.03)tDelayed Graft Function (DGF)t31.3%Donor type (DBD:DCD)t5:2tEpisode of Rejectiont6.3%Admission creatinine (u00b5mol/l) t98.1(+/- 36.9)tCreatinine 7 days (u00b5mol/l)t525(+/- 254)Retrieval creatinine (u00b5mol/l) t204(+/- 101.4)tCreatinine 1 month (u00b5mol/l)t195(+/- 91.6)Urine Output in last hour (ml)t120tCreatinine 3 months (u00b5mol/l)t174(+/- 85.9)History of hypertensiont28.6%tCreatinine 6 months (u00b5mol/l)t170(+/- 89.2)History of diabetest0%tCreatinine 12 months (u00b5mol/l)t157(+/- 85.9)Proteinuria >30mg/dl (+)t35.7%tMortalityt0%Haematuriat57.1%tLength of stay (days)t11.2(+/- 5.88)The mean donor age was 51.9 years (range 11-76 years). 71.4% were DBD donors. 28.6% were DCD. The mean donor serum creatinine on admission was 98.1 u00b5mol/L, and 204 u00b5mol/L at retrieval. 28.6% had a history of hypertension. Mean recipient age was 51.3 years (range 29-68 years). The mean serum creatinine at 7 days post-transplant was 525 u00b5mol/L. Mean serum creatinine at 1, 3, and 6 months were 195, 174 and 170 u00b5mol/l respectively. One year mean serum creatinine was 157 u00b5mol/l. Average length of stay was 11.2 days. 31.3% of recipients had DGF. 1 recipient had an episode of rejection, which was successfully treated. 12 month graft survival was 100%. 1 recipient was treated for acute CMV infection at 5 months post-transplant. 1 recipient developed adenocarcinoma of the colon at 12 months. There were no mortalities.Conclusions: This study suggests that AKI donor outcomes are acceptable. Whilst extreme offer variables are often declined, this study suggests that AKI donors should be considered as a feasible way of expanding the deceased donor pool. However, further larger scale studies are required to fully evaluate this. These studies could include further evaluation of AKI Stage 3 donors (2 patients in our study), and longer-term outcomes.

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