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Clinically adjudicated deceased donor acute kidney injury and graft outcomes
被引:2
|作者:
Mansour, Sherry G.
[1
,2
]
Khoury, Nadeen
[3
]
Kodali, Ravi
[2
]
Virmani, Sarthak
[2
]
Reese, Peter P.
[4
,5
,6
]
Hall, Isaac E.
[7
]
Jia, Yaqi
[8
]
Yamamoto, Yu
[1
]
Thiessen-Philbrook, Heather R.
[8
]
Obeid, Wassim
[8
]
Doshi, Mona D.
[9
]
Akalin, Enver
[10
]
Bromberg, Jonathan S.
[11
,12
]
Harhay, Meera N.
[13
,14
,15
]
Mohan, Sumit
[16
,17
]
Muthukumar, Thangamani
[18
,19
]
Singh, Pooja
[20
]
Weng, Francis L.
[21
]
Moledina, Dennis G.
[1
,2
]
Greenberg, Jason H.
[1
,2
]
Wilson, Francis P.
[1
,2
]
Parikh, Chirag R.
[8
]
机构:
[1] Yale Univ, Sch Med, Clin & Translat Res Accelerator, New Haven, CT USA
[2] Yale Univ, Sch Med, Dept Internal Med, Sect Nephrol, New Haven, CT 06510 USA
[3] Henry Ford Hlth Syst, Div Nephrol, Detroit, MI USA
[4] Univ Penn, Perelman Sch Med, Renal Electrolyte & Hypertens Div, Dept Med, Philadelphia, PA 19104 USA
[5] Univ Penn, Perelman Sch Med, Dept Biostat Epidemiol & Informat, Philadelphia, PA 19104 USA
[6] Univ Penn, Perelman Sch Med, Dept Med Eth & Hlth Policy, Philadelphia, PA 19104 USA
[7] Univ Utah, Sch Med, Dept Internal Med, Div Nephrol & Hypertens, Salt Lake City, UT USA
[8] Johns Hopkins Univ, Sch Med, Div Nephrol, Baltimore, MD 21205 USA
[9] Univ Michigan, Med Sch, Dept Internal Med, Div Nephrol, Ann Arbor, MI 48109 USA
[10] Montefiore Med Ctr, Albert Einstein Coll Med, Montefiore Einstein Kidney Transplant Program, Bronx, NY 10467 USA
[11] Univ Maryland, Sch Med, Dept Surg, Div Transplantat, Baltimore, MD 21201 USA
[12] Univ Maryland, Sch Med, Dept Microbiol & Immunol, Baltimore, MD 21201 USA
[13] Drexel Univ, Coll Med, Dept Internal Med, Philadelphia, PA 19104 USA
[14] Drexel Univ, Dornsife Sch Publ Hlth, Dept Epidemiol & Biostat, Philadelphia, PA 19104 USA
[15] Tower Hlth Syst, Tower Hlth Transplant Inst, W Reading, PA USA
[16] Columbia Univ, Mailman Sch Publ Hlth, Dept Epidemiol, New York, NY USA
[17] Columbia Univ, Vagelos Coll Phys & Surg, Dept Med, Div Nephrol, New York, NY USA
[18] New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med, Div Nephrol & Hypertens, New York, NY USA
[19] New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Transplantat Med, New York, NY USA
[20] Thomas Jefferson Univ Hosp, Sidney Kimmel Med Coll, Dept Med, Div Nephrol, Philadelphia, PA 19107 USA
[21] RWJBarnabas Hlth, St Barnabas Med Ctr, Livingston, NJ USA
来源:
基金:
美国国家卫生研究院;
关键词:
ACUTE TUBULAR-NECROSIS;
TRANSPLANTATION;
ASSOCIATIONS;
PATIENT;
BIOMARKERS;
CREATININE;
ALLOGRAFT;
DIAGNOSIS;
AZOTEMIA;
FAILURE;
D O I:
10.1371/journal.pone.0264329
中图分类号:
O [数理科学和化学];
P [天文学、地球科学];
Q [生物科学];
N [自然科学总论];
学科分类号:
07 ;
0710 ;
09 ;
摘要:
Background Acute kidney injury (AKI) in deceased donors is not associated with graft failure (GF). We hypothesize that hemodynamic AKI (hAKI) comprises the majority of donor AKI and may explain this lack of association. Methods In this ancillary analysis of the Deceased Donor Study, 428 donors with available charts were selected to identify those with and without AKI. AKI cases were classified as hAKI, intrinsic (iAKI), or mixed (mAKI) based on majority adjudication by three nephrologists. We evaluated the associations between AKI phenotypes and delayed graft function (DGF), 1-year eGFR and GF. We also evaluated differences in urine biomarkers among AKI phenotypes. Results Of the 291 (68%) donors with AKI, 106 (36%) were adjudicated as hAKI, 84 (29%) as iAKI and 101 (35%) as mAKI. Of the 856 potential kidneys, 669 were transplanted with 32% developing DGF and 5% experiencing GF. Median 1-year eGFR was 53 (IQR: 41-70) ml/min/1.73m(2). Compared to non-AKI, donors with iAKI had higher odds DGF [aOR (95%CI); 4.83 (2.29, 10.22)] and had lower 1-year eGFR [adjusted B coefficient (95% CI): -11 (-19, -3) mL/min/1.73 m(2)]. hAKI and mAKI were not associated with DGF or 1-year eGFR. Rates of GF were not different among AKI phenotypes and non-AKI. Urine biomarkers such as NGAL, LFABP, MCP-1, YKL-40, cystatin-C and albumin were higher in iAKI. Conclusion iAKI was associated with higher DGF and lower 1-year eGFR but not with GF. Clinically phenotyped donor AKI is biologically different based on biomarkers and may help inform decisions regarding organ utilization.
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