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

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.

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.

‘Injured kidneys could be suitable for transplantation and this brings hope to patients in the transplant waiting list. Henceforth, acutely injured kidneys could become part of the donor pool.’
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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 sayingOur 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.”

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 addEven 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.

References :

  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