Patients who receive transplanted kidneys from deceased donors (DDs) age 60 and older with acute kidney injury (AKI) have worse allograft outcomes than some other DD kidney recipients, according to new research discussed at the 2019 American Transplant Congress in Boston.

A team led by J. Kim, MD, of Daejeon St. Mary’s Hospital at the Catholic University of Korea, examined clinical outcomes for 709 kidney transplant recipients (KTRs) receiving kidneys from 569 DDs at 4 transplant centers. For analyses, KTRs were stratified by donor age (younger or older than 60 years) and the presence of donor AKI.

Allograft function deteriorated significantly more in recipients of AKI kidneys from older versus younger DDs: Estimated glomerular filtration rate (eGFR) was 46.8 vs 56.0; 45.3 vs 56.0; and 46.7 vs 61.4 mL/min/1.73 m2 at 3, 6, and 12 months after transplant, respectively, by the Modification of Diet in Renal Disease equation. At 12 months, grafts from AKI-young DDs fared similarly to those from elderly DDs without AKI. 

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Interstitial fibrosis and tubular atrophy occurred at significantly higher rates in grafts from the AKI-elderly-DD group than the AKI-young, non-AKI young, and non-AKI elderly groups (50.0% vs 33.1% vs 28.6% vs 25%), according to allograft biopsy results within 3 months of transplant. Mean glomerular sclerosis also was significantly higher in the AKI-elderly-KT group than the younger groups with and without AKI (20.3% vs 8% vs 4.9%, respectively). Acute rejection did not differ significantly among the groups.

Overall, the AKI-elderly-KT group had a significantly worse allograft survival rate than the other 3 groups, although patient survival did not differ.

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Kim J, Lee J, Kim Y, Jin K, Han S, Hong Y, Chang Y, Kim S, Yoon H, Yang C, Park W, Chung B. Impact of Acute Kidney Injury in Elderly Deceased Donor on the Post-Transplant Clinical Outcomes [abstract]. Am J Transplant. 2019;19 (suppl 3). Presented at the 2019 American Transplant Congress in Boston, June 1-5. Abstract C92.