Comparative Analysis Of Therapeutic Effect Of Deceased Donor Kidney Transplantation With Acute Kidney Injury

Objective:To explore the clinical effect of renal transplant from deceased donor(DD)with acute kidney injury(AKI).Method:This was an observational retrospective study of 763 patients who underwent renal transplantation from 390 deceased donors’ kidneys at the the second Department of Urology,the first hospital of Jilin University from January 2015 to January 2020.The transplant patients were divided into AKI group and non-AKI group according to the Kidney Disease: Improving Global Outcomes(KDIGO)criteria based on initial and terminal creatinine values.According to the criteria of KDIGO diagnosis and classification,the AKI group was divided into KDIGO stage 1 group,KDIGO stage 2 and 3group.The incidence of DGF,PNF,AR,pulmonary infection,the level of serum creatinine in the short and long term,the survival rate of kidney transplantation and patients were observed.Result:1.There were 61 deceased donors with AKI,and the incidence of AKI was15.64%.According to the KDIGO grading diagnostic criteria,there were 56 cases of KDIGO stage 1 group and 5 cases of KDIGO stage 2 and 3 group.2.The incidence of postoperative DGF in non-AKI group,KDIGO stage 1group and KDIGO stage 2 and 3 group was 10.26%,7.27% and 40%,respectively.The difference between KDIGO stage 2 and 3 group and non-AKI group and KDIGO stage 1 group was statistically significant(P<0.05).In the comparison of serum creatinine at 7 days and 30 days after operation,the differences between the KDIGO stage 2 and 3 group and the non-AKI group and the KDIGO stage 1 group were statistically significant(P<0.05).There was no significant difference in serum creatinine between the KDIGO stage 1 group and the non-AKI group at each time point within 5 years after operation.3.In the non-AKI group,the incidence of postoperative acute rejection was12.75%,and the incidence of pulmonary infection was 8.24%.The incidence of postoperative acute rejection in KDIGO stage 1 group was 13.64%,and the incidence of pulmonary infection was 8.18%.The incidence of acute rejection was 20% and the incidence of pulmonary infection was 30% in KDIGO stage 2and 3 group.There was no significant difference among the three groups.4.There was no significant difference in graft and recipient survival rates within 5 years after renal transplantation among non-AKI group,KDIGO stage1 group and KDIGO stage 2 and 3 group.Conclusion:1.There was no difference in the incidence of DGF and the short-term and long-term serum creatinine levels between KDIGO stage 1 donor kidney and non-AKI donor kidney in AKI classification,suggesting that KDIGO stage 1donor kidney may be an option to expand the donor kidney.2.Compared with non-AKI and KDIGO stage 1 donors,KDIGO stage 2 and3 donors had higher incidence of DGF and higher short-term(within one month)serum creatinine level,but the long-term(5 years)serum creatinine level was similar to that of non-AKI and KDIGO stage 1 donors.It is suggested that KDIGO stage 2 and 3 donor kidneys should be carefully selected and further evaluated.