Less-than-perfect kidneys can be successfully used for transplants, study shows

January 08, 2020

A new Johns Hopkins Medicine-led study provides the strongest evidence to date that hundreds of deceased donor kidneys, discarded each year after being deemed not suitable under current medical criteria, can be transplanted safely and effectively.

Based on its findings reported in the Jan. 8, 2020, issue of JAMA Network Open, the research team strongly recommends that harvested kidneys with acute kidney injury (AKI) no longer be rejected outright, in order to bolster efforts to reduce the drastic shortage of organs available for transplant in the United States. Currently, the national discard or rejection rate for all potential donor kidneys is approximately 18%, but for AKI kidneys, it jumps to about 30%.

According to October 2019 statistics from the U.S. Department of Health and Human Services, some 95,000 Americans with kidney failure -- also known as end-stage renal disease, or ESRD -- are awaiting donor organs. Unfortunately, as reported by the U.S. Centers for Disease Control and Prevention, nearly 9,000 of these patients drop off the waiting list each year because they cannot get a kidney in time, succumbing to death or deteriorating health that makes transplantation no longer possible.

Making matters worse, says the National Institute of Diabetes and Digestive and Kidney Diseases, the need for donor kidneys is rising at 8% per year, yet their availability has not grown to match.

The latest research confirms on a larger scale the results of an earlier study by Johns Hopkins Medicine-led researchers showing that acutely injured deceased-donor kidneys do not fail or get rejected after transplantation at any greater rate than noninjured kidneys from similar deceased donors.

"We estimate there may hundreds of kidneys with AKI each year that are going unused but could be transplanted," says Chirag Parikh, M.D., Ph.D. M.B.B.S., director of the Division of Nephrology at the Johns Hopkins University School of Medicine and senior author of the JAMA Network Open paper. "Therefore, we are urging the transplant community to bring AKI kidneys into the donor pool with more confidence."

AKI, as described by the National Kidney Foundation, is a "sudden episode of kidney failure or kidney damage that happens within a few hours or a few days." This causes waste products to build up in the blood, making it hard for kidneys to maintain the correct balance of fluids in the body.

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.
-end-
Along with Parikh, the research team members from the Johns Hopkins University School of Medicine are Caroline Liu, M.H.S.; Heather Thiessen Philbrook, M-Math; and Yaqi Jia, M.P.H. The team also includes Isaac Hall, M.D., M.S., of the University of Utah School of Medicine and Sherry Mansour, D.O., M.S., of the Yale School of Medicine.

No conflicts of interest related to this study were reported.

Funding for the study was provided by National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases grants R01DK-93770 and K24DK090203, as well as a grant from the George M. O'Brien Kidney Center at the Yale School of Medicine.

Johns Hopkins Medicine

Related Kidney Failure Articles from Brightsurf:

UC research finds low rates of contraceptive use in women with kidney failure
New research from the University of Cincinnati finds that women with kidney failure have low rates of contraceptive use.

Why do minorities have higher rates of kidney failure?
A new study indicates that Blacks and Hispanics have experienced higher rates of kidney failure compared with whites due to more rapid kidney function decline.

The economic burden of kidney transplant failure in the United States
A recent analysis published in the American Journal of Transplantation estimates that for the average US patient who has undergone kidney transplantation, failure of the transplanted organ (graft failure) will impose additional medical costs of $78,079 and a loss of 1.66 quality-adjusted life years.

Heart disease linked to a higher risk of kidney failure
In adults followed for a median of 17.5 years, cardiovascular diseases--including heart failure, atrial fibrillation, coronary heart disease, and stroke--were each linked with a higher risk of developing kidney failure.

Compound offers prospects for preventing acute kidney failure
Russian researchers from the Moscow Institute of Physics and Technology, the Institute of Cell Biophysics, and elsewhere have shown an antioxidant compound known as peroxiredoxin to be effective in treating kidney injury in mice.

New study confirms protective effect of diabetes drugs against kidney failure
A new meta-analysis published in Lancet Diabetes and Endocrinology has found that SGLT2 inhibitors can reduce the risk of dialysis, transplantation, or death due to kidney disease in people with type 2 diabetes.

Is kidney failure a man's disease?
A new analysis of the ERA-EDTA Registry [1] reveals a striking gender difference in the incidence and prevalence of end-stage renal disease.

Kidney failure on the rise in Australians under 50 with type 2 diabetes
A study of more than 1.3 million Australians with diabetes has found that kidney failure is increasing in people with type 2 diabetes aged under 50 years, leading to reduced quality of life and placing growing demand on the country's kidney dialysis and transplantation services.

Frailty may lower kidney failure patients' likelihood of receiving a transplant
Frailty is associated with decreased access at multiple stages in the pathway to kidney transplantation.

Obesity surgery prevents severe chronic kidney disease and kidney failure
Patients that underwent weight-loss surgery ran a significantly lower risk of developing severe chronic kidney disease and kidney failure, when compared to conventionally treated patients, according to a study published in International Journal of Obesity.

Read More: Kidney Failure News and Kidney Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.