May 09, 2024
How do you narrow the increasing gap between patients waiting for a kidney transplant and eligible donors? Expand the donor pool with an innovative approach. Mayo Clinic in Arizona accepts acute kidney injury (AKI) kidneys, including those from donors requiring temporary dialysis at the time of their donations, with successful transplant outcomes.
The Transplant Center has experience using AKI kidneys from donors undergoing temporary dialysis, but the duration of donor dialysis before donation had not been investigated. Researchers in transplant surgery at Mayo Clinic in Arizona sought to investigate the relationship between donor dialysis duration (the length of time the donor had been requiring temporary dialysis) and kidney transplant outcomes.
Does dialysis duration matter?
In a study published in the January 2024 issue of the Journal of the American College of Surgeons (JACS), the researchers found that the duration of donor dialysis did not adversely affect outcomes.
The study reviewed patients who received deceased donor kidney transplants from donors with AKI and on dialysis at Mayo Clinic in Arizona between 2010 and 2022. The patients were divided into three groups based on the predetermined interquartile range of donor dialysis of 1 to 2 days, 3 to 4 days, and five or more days.
A preimplantation (procurement) frozen section wedge biopsy was performed on AKI kidneys before transplantation as part of the Transplant Center's protocol. Kidneys with more than 10% cortical necrosis were not transplanted.
More organ options
Mayo Clinic in Arizona has some of the shortest waiting times for kidney transplant in the country. "This is a result of our organ acceptance practices and our team. Metrics like organ acceptance and likelihood of getting a deceased donor kidney are public data, but these data can be confusing and difficult to interpret," says Caroline C. Jadlowiec, M.D., a transplant surgeon and the surgical director of the Kidney Transplant Program at Mayo Clinic in Arizona, as well as one of the JACS article's authors. "AKI kidneys are underutilized, and because of our experience, we accept these kidneys and are able to transplant more patients, including highly sensitized patients," says Dr. Jadlowiec.
Other centers may not use AKI kidneys due to:
- Higher likelihood of delayed graft function (DGF), the need for temporary dialysis after transplant.
- Risk of kidney allograft nonfunction.
- Acute rejection risk.
- Prolonged hospitalization.
- Increased resource use.
- Inferior graft function or survival.
Mayo Clinic in Arizona transplant surgeons look at the risks differently. "For all the data supporting these potential risks, there is an equal if not greater amount of data supporting potential benefits," says Dr. Jadlowiec. "We always ask, 'Why can't we use that organ?' This is the innovative spirit of our team."
It is seeing possible donor organs that can successfully be transplanted where other centers do not.
AKI kidneys expertise
A collective team effort allows for the successful use of organs that have historically been discarded. "As we gained experience transplanting AKI kidneys, we also established support services within our transplant center to better optimize transplant outcomes. For example, the availability of our pathology team to help review kidney biopsies with us," says Dr. Jadlowiec.
Mayo Clinic in Arizona was one of the first transplant centers to investigate AKI kidneys. As shown in Mayo Clinic's early experience, AKI kidneys often came from young donors. "What we found is that if there are no preexisting chronic changes (CKD), and the AKI event is reversible, these kidneys will go back to being normal young kidneys after transplant, and that is exactly what we validated," says Dr. Jadlowiec.
Key findings
- Of the 254 recipients of kidneys from donors on temporary dialysis at the time of their donations, DGF was observed in most recipients (87% to 94%).
- The DGF duration (length of time someone might require temporary dialysis after kidney transplant) did not vary among the three groups (and most recipients were able to discontinue dialysis within two weeks following kidney transplant).
- Most patients did not require any early hospital readmissions (within 30 days of kidney transplant).
- The one-year patient and graft survival rates were excellent.
With an increasing number of patients waiting for a kidney transplant and not enough eligible donors, the researchers say kidneys coming from donors on temporary dialysis are a safe way to increase access for those needing kidney transplants.
For more information
Punukollu R, et al. Duration of dialysis in acute kidney injury donors and transplant outcomes. Journal of the American College of Surgeons. 2024;238:61.
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