Title :

Association Between Deceased Donor Acute Kidney Injury Assessed Using Baseline Serum Creatinine Back-Estimation and Graft Survival: Results From the French National CRISTAL Registry.

Author(s) :

Lenain, Remi [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Prouteau, Camille [Auteur]
Service de Néphrologie et Transplantation rénale [CHRU-lille]
Hamroun, Aghiles [Auteur]
Foucher, Yohann [Auteur]
MethodS in Patients-centered outcomes and HEalth ResEarch [SPHERE]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Giral, Magali [Auteur]
Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology [U1064 Inserm - CR2TI]
Institut de transplantation urologie-néphrologie [ITUN]
Maanaoui, Mehdi [Auteur]
Recherche translationnelle sur le diabète - U 1190 [RTD]
Service de Néphrologie et Transplantation rénale [CHRU-lille]
Hazzan, Marc [Auteur]
Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Journal title :

American Journal of Kidney Diseases

Abbreviated title :

Am J Kidney Dis

Publication date :

2021-08-26

ISSN :

1523-6838

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Rationale & Objective Deceased donor acute kidney injury (AKI) frequently leads to kidney discards, but its impact on long-term graft survival in kidney transplant recipients remains unclear. We investigated the association ...
Show more >Rationale & Objective Deceased donor acute kidney injury (AKI) frequently leads to kidney discards, but its impact on long-term graft survival in kidney transplant recipients remains unclear. We investigated the association between deceased donor AKI assessed using back-estimation of baseline serum creatinine (Scr) and graft survival. Study Design Observational cohort study. Setting & Participants Adult patients represented within the French CRISTAL registry who received a single kidney allograft from brain-dead deceased donors between January 2006 and December 2017. Exposure A back-estimated Scr baseline value was derived for an assumed glomerular filtration rate at 75 mL/min/1.73 m2, using the MDRD Study equation. A refined classification system for donor AKI was implemented as follows: no AKI, undetermined AKI/chronic kidney disease (CKD), recovery from AKI, and ongoing AKI. Outcome Death-censored graft survival. Analytical Approach Multivariable Cox models using a robust variance estimator for paired kidneys from the same donor. Results We classified 26,786 recipients as follows: no AKI (n = 19,276); undetermined AKI/CKD (n = 1,745); recovery from AKI (n = 2,392); and ongoing AKI (n = 3,373). We observed 4,458 kidney graft losses during a median follow-up period of 5.7 years. Compared with no AKI, ongoing AKI was associated with an increased risk of graft failure (hazard ratio [HR], 1.24 [95% CI, 1.13-1.35]). The HRs for graft failure in the undetermined AKI/CKD and recovery from AKI groups (1.22 [95% CI, 1.07-1.38] and 1.18 [95% CI, 1.06-1.31], respectively) were similar to those observed in the ongoing AKI group. The adverse effect of deceased donor AKI was no longer evident when relying either on the admission or the lowest Scr throughout the procurement procedure as baseline Scr. Limitations No measurement of urine output in donors. Conclusions Deceased donor ongoing AKI, undetermined AKI/CKD, and recovery from AKI according to back-estimated baseline Scr are associated with decreased graft survival. The definition of baseline Scr as the first value measured on admission would have led to a misclassification bias and erroneous estimates.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286
• Recherche translationnelle sur le diabète (RTD) - U1190

Submission date :

2024-01-12T06:10:20Z
2024-03-01T15:18:20Z