Acutely Injured Kidneys are ‘Safe’ for Transplants

Highlights:

• Acutely injured kidneys could become part of the donor pool
• New study brings hope to patients in the transplant waiting list
• Kidneys of deceased donors are safe and suitable for transplantation

At a time when the entire world is facing acute shortage of organs, a new study from the United States brings hope to the billions waiting to undergo a kidney transplant surgery. A kidney transplant surgery is recommended for patients suffering from end-stage kidney disease and involves a surgical procedure to implant a healthy kidney from a deceased or living donor. The study which was chaired by a John Hopkins kidney specialist, recommends that severely injured donor kidneys should be used for such transplantation procedures and not be discarded.

The specialists involved in organ procurement generally tend to overlook kidneys that are damaged owing to injuries or those from donors with diabetes or hypertension. While the rejection rate for:

• all potential donor kidneys is around 18 percent in the US and
• acute kidney injury (AKI) kidneys are rejected at a rate of 30 percent

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Are Acutely Injured Kidneys ‘Safe’ for Transplants?

Acute kidney injury(AKI) is a type of kidney damage that may occur within a short span of time, preventing the kidney from balancing body fluids and affecting other organs. AKI is very common in the intensive care units of hospitals where patients are placed on ventilators or given medication to maintain blood pressure following surgeries or trauma. Patients who develop AKI are more likely to have chronic kidney diseases and die prematurely. Therefore, physicians are uncertain about using these kidneys in transplants as it is unclear if the recipients will also meet with the same consequences.

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Details of the Study

The study aiming to alleviate such fears used medical chart reviews of 2,430 kidneys transplanted from 1,298 donors - out of which 585 were AKI kidneys, to study rejection rates. The research team did not find any difference in rejection rates between non-AKI and AKI kidneys. Additionally, no evidence was found to suggest that the duration of chilling an organ, without blood supply did not have any impact on recipients who received AKI kidneys.

Chirag R. Parikh, M.B.B.S., Ph.D., Director of the Division of Nephrology at the Johns Hopkins University School of Medicine, who is the also the senior study author, was quoted saying "Our results should add to evidence and reassure the general public and the transplant community that acutely injured deceased-donor kidneys appear to have the same success rates as noninjured kidneys from otherwise similar donors."

About one-third of the patients in ICUs develop AKI, and the transplant teams should take measures to expand the donor pool by including AKI kidneys. On how this study would help the medical community significantly, he mentioned that "Hopefully this study will provide confidence to surgeons that they can transplant these kidneys and expect good outcomes."

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Rejection of Acutely Injured Kidneys

Dr. Parikh also threw light on the organ shortage scenario in the US, where around 95,000 Americans are on the waiting list for kidney transplant according to U.S. Organ Procurement and Transplantation Networks. On the contrary, data from the United Network for Organ Sharing suggests that approximately 2,000 donor kidneys are rejected in a year owing to various criteria used to measure kidney function.

With regard to rejection of AKI kidneys, Dr. Parikh says "We estimate there may be approximately 500 kidneys a year with AKI that are currently discarded, but can be transplanted." He went on to add “Even transplanted kidneys with the highest severity of AKI did not have worse outcomes, so we should bring these kidneys into the donor pool with confidence," considering the scarcity.

The two-part study used chart review data for kidneys of 1,298 donors from 2010-2013 to compare the profiles of both AKI and non-AKI donors and recipients in its first phase. The findings revealed that the severity of AKI did not impact the graft failure rates. The second part focused on examination of charts of a group of recipients to specifically study graft failures and progression to kidney diseases. About 143 recipients presented the symptoms of which only 40 had received AKI kidneys.

Findings of the Study

The findings of the study published in an issue of Kidney International suggest that by including the AKI kidneys in the donor pool, patients will have access to increased number of kidneys, thereby narrowing the waiting list.

The research team have also cautioned that there is always the possibility of AKI kidneys used for transplant are prone to having higher risk factor distribution than the non-AKI kidneys. They are less likely to be used for transplants unless they have characteristics in their favor like age and absence of chronic diseases.

Transplant procedures are seen as major revenue savers for the health-care system andthis study is relevant at this time where the field of medicine is trying to step towards balancing cost and patient safety. The study concludes that kidneys of deceased donors with acute kidney injury (AKI) are safe and suitable for transplantation.

Reference:

1. Medical Records Study Suggests Kidneys from Deceased Donors with Acute Kidney Injury are Suitable for Transplant - (https://www.hopkinsmedicine.org/news/newsroom/news-releases/medical-records-study-suggests-kidneys-from-deceased-donors-with-acute-kidney-injury-are-suitable-for-transplant )

Source-Medindia