Stabilization of estimated glomerular filtration rate in kidney transplantation from deceased donors with acute kidney injuries

Table 1 Baseline characteristics

DDKT (n = 111)	SCD (32)	AKI (51)	ECD (28)	aP-value	bP-value
Recipients
Age year (mean ± SD)	42.7 ± 13.8	43.9 ± 12.0	43.1 ± 12.3	0.68	0.67
Male n (%)	19 (59.4)	35 (68.6)	16 (57.1)	0.48	0.55
Pre KT dialysis				1	1
Hemodialysis n (%)	26 (81.3)	42 (82.4)	23 (82.1)
Peritoneal dialysis n (%)	6 (18.8)	9 (17.7)	5 (17.9)
Comorbid n (%)
DM	2 (6.25)	8 (15.7)	3 (10.7)	0.3	0.48
HT	30 (93.8)	49 (96.1)	25 (89.3)	0.67	0.41
CAD	1 (3.1)	1 (1.9)	1 (3.6)	1	1
Cause of ESRD n (%)				0.91	0.73
Unknown (no biopsy)	23 (23.2)	33 (31.8)	18 (18.9)
Diabetic nephropathy	1 (0.9)	1 (1.3)	1 (0.8)
IgA nephropathy	1 (1.9)	2 (2.6)	3 (1.5)
Chronic glomerulonephritis	2 (0.9)	1 (1.3)	0 (0.8)
Blood group n (%)				0.14	0.38
A	4 (12.5)	13 (25.5)	7 (25.0)
B	13 (40.6)	13 (25.5)	7 (25.0)
AB	4 (12.5)	2 (3.9)	3 (10.7)
O	11 (34.4)	23 (45.1)	11 (39.3)
PRA - % median (range)	0 (0.85)	0 (0.0)	0 (0.0)	0.03	0.04
Second KT n (%)	2 (6.25)	3 (5.88)	1 (3.57)	1	1
Total HLA mismatch - (mean ± SD)	2.5 (1.2)	2.3 (1.1)	2.1 (1.1)	0.52	0.76
Donors
Age, year (mean ± SD)	33.9 ± 14.8	41.0 ± 12.0	61.2 ± 7.0	0.02	< 0.001
Male n (%)	24 (75.0)	44 (86.3)	17 (60.7)	0.25	0.04
Terminal serum creatinine (mg/dL) - median (range)	0.91 (0.73, 1.13)	2.22 (1.65, 3.20)	1.28 (0.99, 2.70)		< 0.001
Cold ischemic time, minute (mean ± SD)	1099 ± 291	1129 ± 294	1261 ± 242	0.65	0.5
Immunosuppressive drugs
Induction n (%)				0.11	0.19
No	16 (50.0)	16 (31.4)	9 (32.1)
ATG	5 (15.6)	11 (21.6)	11 (39.3)
Simulect	11 (34.4)	24 (47.1)	8 (28.6)
Maintenance n (%)				0.05	0.005
Tacrolimus/mycophenolate/prednisolone	16 (50.0)	27 (52.9)	13 (46.4)
Cyclosporin A/mycophenolate/prednisolone	15 (46.8)	16 (31.4)	5 (17.9)
Cyclosporin A/everolimus/prednisolone	0	7 (13.7)	8 (28.6)
Everolimus/mycophenolate/prednisolone	1 (3.1)	0	0

^aP-value compared between SCD and AKI;

^bP-value compared among SCD, AKI and ECD. DDKT: Deceased donor kidney transplant; SCD: Standard criteria donor; AKI: Acute kidney injury; ECD: Expanded criteria donor; KT: Kidney transplant; DM: Diabetes mellitus; HT: Hypertension; CAD: Cardiovascular disease; ESRD: End stage renal disease; HLA: Human leukocyte antigen; ATG: Antithymocyte globulin.

Table 2 Transplantation outcomes

Outcomes	SCD (32)	AKI (51)	ECD (28)	aP-value	bP-value
Cr at discharge - mg/dL (mean ± SD)	1.35 ± 0.51	1.70 ± 0.84	2.41 ± 1.00	0.04	< 0.001
Cr at 1 yr - mg/dL (mean ± SD)	1.35 ± 0.50	1.59 ± 0.75	2.64 ± 1.38	0.14	< 0.001
Cr at 2 yr - mg/dL (mean ± SD)	1.52 ± 0.63	1.68 ± 1.06	3.29 ± 2.12	0.47	< 0.001
eGFR at discharge - mL/min (mean ± SD)	64.1 ± 22.1	52.5 ± 22.9	35.5 ± 17.9	0.03	< 0.001
eGFR at 1 yr - mL/min (mean ± SD)	63.6 ± 19.9	56.6 ± 23.9	33.9 ± 17.3	0.19	< 0.001
eGFR at 2 yr - mL/min (mean ± SD)	58.6 ± 23.2	56.6 ± 24.5	29.9 ± 19.2	0.65	< 0.001
DGF n (%)	10 (31.2)	29 (56.9)	21 (77.8)	0.03	0.001
Length of stay - d (mean ± SD)	24.4 ± 8.3	31.1 ± 14.7	37.9 ± 15.3	0.02	0.002
Nephrectomy n (%)	0	2 (3.9)	2 (7.4)	0.52	0.27
Acute rejection	5 (15.7)	10 (19.6)	6 (27.4)	0.70	0.8
ACR	2 (6.3)	6 (11.8)	2 (7.1)
ABMR	1 (3.1)	3 (5.9)	3 (10.7)
ACR + ABMR	2 (6.3)	1 (1.9)	1 (3.6)
Graft loss n (%)	0	0	3 (11.5)	NS	0.01
Death n (%)	2 (6.3)	3 (5.1)	3 (10.7)	0.63	0.57
CMV n (%)	7 (5.2)	6 (8.3)	5 (4.5)	0.23	0.46
BK virus nephropathy n (%)	1 (3.1)	3 (5.69)	0	1	0.69

eGFR: Estimated glomerular filtration rate; DGF: Delayed graft function; ACR: Acute cellular rejection; ABMR: Antibody mediated rejection; CMV: Cytomegalovirus.

Table 3 Estimated glomerular filtration rate classified by acute kidney injury network stage

eGFR - mean ± SD	SCD (n)(32)	AKIN stage (n)			P-value
		1 (18)	2 (21)	3 (12)
eGFR at discharge - mL/min	64.1 ± 22.1	49.8 ± 20.7	57.1 ± 23.7	49.6 ± 27.2	0.87, 0.07
eGFR at 1 yr - mL/min	63.6 ± 19.9	52.9 ± 21.2	57.1 ± 21.5	61.9 ± 29.0	0.47, 0.92
eGFR at 2 yr - mL/min	58.6 ± 23.2	53.4 ± 24.3	54.0 ± 21.4	64.0 ± 29.4	0.79, 0.54

AKIN: Acute kidney injury network; eGFR: Estimated glomerular filtration rate; SCD: Standard criteria donor.

Table 4 Univariate and multivariate regression analysis of factors associated with the change of one-year estimated glomerular filtration rate

Factors	Univariate			Multivariate
	B-coefficient	P-value	95%CI	B-coefficient	P-value	95%CI
Type of donor
SCD	Reference	NA		Reference	NA
AKI	-6.73	0.17	-16.41, 2.94	-3.7	0.49	-14.52, 7.13
ECD	-29.76	< 0.001	-41.67, -17.85	-25.43	< 0.001	-38.80, -12.05
PRA > 20%	3.49	0.64	-7.37, 14.34	3.62	0.53	-7.82, 15.05
DGF	12.3	0.008	3.22, 21.39	6.17	0.18	-2.91, 15.25
HLA mismatch ≥ 3	-2.99	0.53	-12.45, 6.46	-7.12	0.11	-15.77, 1.53
CIT > 24 h	-14.72	0.03	-27.99, -1.45	-9.54	0.14	-22.19, 3.12
Received Induction	4.49	0.36	-5.28, 14.25	1.8	0.72	-8.09, 11.70

The Β-coefficient values were calculated from univariate and multivariate regression analysis. SCD: Standard criteria donor; AKI: Acute kidney injury; ECD: Expanded criteria donor; PRA: Panel reactive antibody; DGF: Delayed graft function; HLA: Human leukocyte antigen.