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AKI symptoms differ depending on the cause and may include: too little urine leaving the body; swelling in the legs and ankles, and around the eyes; fatigue; shortness of breath; confusion; nausea; chest pain; and in severe cases, seizures or coma. The disorder is most commonly seen in hospitalized patients whose kidneys are affected by medical and surgical stress and complications.
In 2018, a team led by Parikh reviewed the medical records documenting approximately 2,500 kidneys transplanted from nearly 1,300 deceased donors -- of which 24% (about 600) had AKI at the time of donation. The researchers reported no significant differences in the rates of organ rejection among kidneys from deceased donors with or without AKI.
For the latest study, the researchers greatly expanded the number of transplanted kidneys analyzed to validate or refute the 2018 results. Organs from 13,444 deceased donors were transplanted into 25,323 ESRD patients in the United States between Jan. 1, 2010 and Dec. 31, 2013. Of this number, 12,810 received kidneys with AKI and 12,513 were given kidneys without any signs of acute injury and that had been matched to the AKI kidneys on other criteria.
For this matching, each AKI kidney was paired at the beginning of the study with a non-AKI kidney using a statistical method that mathematically linked as many donor characteristics as possible, including age, sex, ethnicity and medical conditions other than AKI. This allowed the investigators to more accurately measure the impact, if any, of just AKI on transplant success.
The transplant recipients were followed for four to six years after their surgery.
"We found that deceased-donor AKI had no association with either short-term or long-term survival of the organ, strongly supporting our idea that kidneys with AKI should be actively harvested and transplanted," Parikh says.
To determine how many potentially viable kidneys with AKI were lost during the study period (2010 to 2013), the researchers looked at how many deceased donor kidneys with AKI were recovered, then either transplanted or discarded.
"We found that although nearly 17,500, or 85%, of the more than 20,500 available AKI kidneys were harvested over the three years, only slightly more than 12,700 were transplanted," Parikh says. "This means almost 8,000 organs were either rejected after procurement or never obtained at all simply because the donors had acute kidney injury."
Increasing the donor pool to include AKI kidneys, Parikh adds, would help achieve the goal of the Advancing American Kidney Health initiative, a 2019 presidential directive that aims to double the number of kidneys available for transplant by 2030. Source:
Johns Hopkins Medicine Journal reference:
Liu, C. et al . (2020) Association of Deceased Donor Acute Kidney Injury With Recipient Graft Survival. JAMA Network Open . doi.org/10.1001/jamanetworkopen.2019.18634
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