Effect of creatinine metrics on outcome after transplantation of marginal donor kidneys. Issue 12 (20th September 2022) - Scurt, Florian G.
Abstract: Introduction: Predicting outcome after transplantation of marginal kidneys is a challenging task. Donor creatinine or estimated glomerular filtration rate (eGFR) are integral components of the respective risk scores. However, there is uncertainty on which of their values obtained successively during procurement is the most suitable. Material and methods: This is a retrospective study of 221 adult brain death donors with marginal kidneys, transplanted in 223 recipients. We applied logistic regression analysis to investigate the association between initial (at hospital admission), nadir (lowest), zenith (highest) and terminal (at recovery) donor eGFR with primary non‐function (PNF), delayed graft function (DGF), 3‐ and 12‐month graft function and 1‐ and 3‐year patient‐ and death‐censored graft survival. Results: In the multivariate analysis, admission, terminal, and the lowest donor eGFR could most accurately predict DGF. The respective ORs [95% CI] were: 0.875 [0.771–0.993], 0.818 [95% CI: 0.726–0.922] and 0.793 [0.689–0.900]. Although not being significant for DGF (OR 0.931 [95% CI: 0.817–1.106]), the highest eGFR was the best predictor of 3‐month graft function (adjusted b coefficient 1.161 [95% CI: 0.355–1.968]). Analysis of primary nonfunction showed that determination of initial and the highest eGFR proved to be the best predictors. The respective ORs [95% CI] were: 0.804 [0.667–0.968] and 0.750 [0.611–0.919]. There were no differences in the risk associations of each of the four eGFR recordings with patient‐ and graft survival. Conclusion: The various eGFR recordings determined during the procurement process of marginal donors can predict PNF, DGF and 3‐ and 12‐month graft function. Regarding short‐term patient‐ and graft survival, there appears to be impacted by recipient factors rather than donor kidney function. Summary at a glance: Predicting outcomes after transplantation of marginal kidneys is a difficult task. The successive donor creatinine recordings obtained from admission to the hospital until organ recovery associate differently with clinically relevant short‐term endpoints, such as primary non‐function, delayed graft function and graft function up to 1 year. However, one‐ and three‐ year patient‐ and graft survival depend more on recipient‐related factors and less on the donor's kidney function.