Clinically adjudicated deceased donor acute kidney injury and graft outcomes.
<h4>Background</h4>Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association.<h4>Methods</h4>In this ancillary analysis of the...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0264329 |
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| author | Sherry G Mansour Nadeen Khoury Ravi Kodali Sarthak Virmani Peter P Reese Isaac E Hall Yaqi Jia Yu Yamamoto Heather R Thiessen-Philbrook Wassim Obeid Mona D Doshi Enver Akalin Jonathan S Bromberg Meera N Harhay Sumit Mohan Thangamani Muthukumar Pooja Singh Francis L Weng Dennis G Moledina Jason H Greenberg Francis P Wilson Chirag R Parikh |
| author_facet | Sherry G Mansour Nadeen Khoury Ravi Kodali Sarthak Virmani Peter P Reese Isaac E Hall Yaqi Jia Yu Yamamoto Heather R Thiessen-Philbrook Wassim Obeid Mona D Doshi Enver Akalin Jonathan S Bromberg Meera N Harhay Sumit Mohan Thangamani Muthukumar Pooja Singh Francis L Weng Dennis G Moledina Jason H Greenberg Francis P Wilson Chirag R Parikh |
| author_sort | Sherry G Mansour |
| collection | DOAJ |
| description | <h4>Background</h4>Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association.<h4>Methods</h4>In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes.<h4>Results</h4>Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI.<h4>Conclusion</h4>iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization. |
| first_indexed | 2024-04-13T05:51:09Z |
| format | Article |
| id | doaj.art-3be2d778ad9340c9bd781a65a255898d |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T05:51:09Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-3be2d778ad9340c9bd781a65a255898d2022-12-22T02:59:46ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01173e026432910.1371/journal.pone.0264329Clinically adjudicated deceased donor acute kidney injury and graft outcomes.Sherry G MansourNadeen KhouryRavi KodaliSarthak VirmaniPeter P ReeseIsaac E HallYaqi JiaYu YamamotoHeather R Thiessen-PhilbrookWassim ObeidMona D DoshiEnver AkalinJonathan S BrombergMeera N HarhaySumit MohanThangamani MuthukumarPooja SinghFrancis L WengDennis G MoledinaJason H GreenbergFrancis P WilsonChirag R Parikh<h4>Background</h4>Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association.<h4>Methods</h4>In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes.<h4>Results</h4>Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m2. Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m2]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI.<h4>Conclusion</h4>iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization.https://doi.org/10.1371/journal.pone.0264329 |
| spellingShingle | Sherry G Mansour Nadeen Khoury Ravi Kodali Sarthak Virmani Peter P Reese Isaac E Hall Yaqi Jia Yu Yamamoto Heather R Thiessen-Philbrook Wassim Obeid Mona D Doshi Enver Akalin Jonathan S Bromberg Meera N Harhay Sumit Mohan Thangamani Muthukumar Pooja Singh Francis L Weng Dennis G Moledina Jason H Greenberg Francis P Wilson Chirag R Parikh Clinically adjudicated deceased donor acute kidney injury and graft outcomes. PLoS ONE |
| title | Clinically adjudicated deceased donor acute kidney injury and graft outcomes. |
| title_full | Clinically adjudicated deceased donor acute kidney injury and graft outcomes. |
| title_fullStr | Clinically adjudicated deceased donor acute kidney injury and graft outcomes. |
| title_full_unstemmed | Clinically adjudicated deceased donor acute kidney injury and graft outcomes. |
| title_short | Clinically adjudicated deceased donor acute kidney injury and graft outcomes. |
| title_sort | clinically adjudicated deceased donor acute kidney injury and graft outcomes |
| url | https://doi.org/10.1371/journal.pone.0264329 |
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