A Study On Therapeutic Efficacy Of Kidney Transplantation Donated By Deceased Adult Citizens With Acute Kidney Injury

Objective: discuss the clinical application value of acute kidney injury(AKI)donor kidney by studying the efficacy of kidney transplantation donated by adult citizens with AKI after death and comparing the survival rate of recipient/transplanted kidney with normal function kidney.Methods: This study were trospectively analyzed the clinical data related to all kidney transplantation donors and recipients who met the inclusion and exclusion criteria in the Organ Transplantation Center of the923 rd Hospital of the People’s Liberation Army Joint Security Force between January 2017 and December 2019: 298 recipients received a donor kidney with normal kidney function classified as non-AKI group and 195 recipients received a donor kidney with acute kidney injury classified as AKI group.We compared the recovery of renal function and the incidence of various complications between the non-AKI group and the AKI group 1 year after transplantation,and performed univariate and multifactorial analyse of delayed graft function(DGF),and analyzed the survival rate of the recipient/transplanted kidney within 4 years after transplantation.Results: 1.Serum creatinine recovered well 1 year after surgery in both non-AKI group and AKI group recipients,with a stable creatinine of(142.10±27.54)μmol/L in the non-AKI group and a stable mean creatinine of(133.83±86.80)μmol/L in the AKI donor group,which is not significantly different for comparison(P=0.2).2.The incidence of acute rejection(AR)within 1 year after transplantation was 14.77% in the non-AKI group and22.56% in the AKI group(P=0.03),with a significant difference.The incidence of DGF was 14.13% in the non-AKI group and 29.23% in the AKI donor group(P=0.000),with a significant difference;there was no significant difference in other complications between two groups(P>0.05).3.Independent risk factors of DGF(donor side): AKI(OR: 2.69,95% CI:2.51-2.88,P=0.000),thermal ischemia time(OR: 1.53,95% CI: 1.43-1.64,P=0.000),blood creatinine before donor kidney acquisition(OR: 1.01,95%CI:1.001-1.014,P=0.02),cold ischemia time(OR: 0.95,95% CI: 0.93-0.98,P=0.00);independent risk factors of DGF(recipient side): diabetes mellitus(OR:0.59,95% CI:0.52-0.67,P=0.000),body mass index(OR:1.05,95%CI:1.03-1.06,P= 0.000).4.There was no significant difference in the survival rate between recipients in non-AKI group and AKI group 4 years after kidney transplantation(P=0.385),whereas there was a significant difference in survival rate of transplanted kidneys between non-AKI group(91.27%)and AKI group(87.69%)(P=0.019).Conclusion: 1.Compared to recipients in non-AKI group,those in AKI group had a smaller decline in Scr within 1 month after transplantation and a slower recovery of urine output during the polyuric phase,but renal function recovered well 1 year after surgery.The incidence of DGF and AR after transplantation was higher in the AKI group than non-AKI group,while there was no significant difference in the incidence of other complications,indicating that the recent clinical outcomes after kidney transplantation were similar in both groups.2.Independent risk factors for DGF: AKI donor,thermal ischemia time,,cold ischemia time,Scr before kidney harvesting;body mass index of the recipient,diabetes mellitus.3.Although the 4-year survival rate of transplanted kidneys in AKI group is slightly lower than those in non-AKI group,kidneys of donors with AKI can still be an important source for kidney transplantation and alleviate organ shortage after careful evaluation.