TY - JOUR
T1 - Past, Current, and Future Perspectives on Transplanting Acute Kidney Injury Kidneys
AU - Punukollu, Rachana
AU - Ryan, Margaret
AU - Misra, Suman
AU - Budhiraja, Pooja
AU - Ohara, Stephanie
AU - Kumm, Kayla
AU - Guerra, Giselle
AU - Reddy, Kunam S.
AU - Heilman, Raymond
AU - Jadlowiec, Caroline C.
N1 - Publisher Copyright:
© 2023 by the authors.
PY - 2023/8
Y1 - 2023/8
N2 - (1) Background: Acute kidney injury (AKI) kidneys have high non-utilization rates due to concerns regarding unfavorable outcomes. In this paper, we aimed to review the past, present, and future opinions on AKI kidneys. (2) Methods: A PubMed search was conducted for topics relevant to AKI kidney transplantation. (3) Results: Current short- and long-term data on AKI kidneys have demonstrated good outcomes including favorable graft function and survival. The role of procurement biopsies is controversial, but they have been shown to be beneficial in AKI kidneys by allowing clinicians to differentiate between reversible tubular injury and irreversible cortical necrosis. Machine perfusion has also been applied to AKI kidneys and has been shown to reduce delayed graft function (DGF). The incidence of DGF increases with AKI severity and its management can be challenging. Strategies employed to counteract this have included early initiation of dialysis after kidney transplantation, early targeting of adequate immunosuppression levels to minimize rejection risk, and establishment of outpatient dialysis. (4) Conclusions: Despite good outcomes, there continue to be barriers that impact AKI kidney utilization. Successful strategies have included use of procurement biopsies or machine perfusion and expectant management of DGF. With increasing experience, better use of AKI kidneys can result in additional opportunities to expand the donor pool.
AB - (1) Background: Acute kidney injury (AKI) kidneys have high non-utilization rates due to concerns regarding unfavorable outcomes. In this paper, we aimed to review the past, present, and future opinions on AKI kidneys. (2) Methods: A PubMed search was conducted for topics relevant to AKI kidney transplantation. (3) Results: Current short- and long-term data on AKI kidneys have demonstrated good outcomes including favorable graft function and survival. The role of procurement biopsies is controversial, but they have been shown to be beneficial in AKI kidneys by allowing clinicians to differentiate between reversible tubular injury and irreversible cortical necrosis. Machine perfusion has also been applied to AKI kidneys and has been shown to reduce delayed graft function (DGF). The incidence of DGF increases with AKI severity and its management can be challenging. Strategies employed to counteract this have included early initiation of dialysis after kidney transplantation, early targeting of adequate immunosuppression levels to minimize rejection risk, and establishment of outpatient dialysis. (4) Conclusions: Despite good outcomes, there continue to be barriers that impact AKI kidney utilization. Successful strategies have included use of procurement biopsies or machine perfusion and expectant management of DGF. With increasing experience, better use of AKI kidneys can result in additional opportunities to expand the donor pool.
KW - acute kidney injury
KW - delayed graft function
KW - donor pool
KW - kidney transplant
KW - organ shortage
UR - http://www.scopus.com/inward/record.url?scp=85169020989&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85169020989&partnerID=8YFLogxK
U2 - 10.3390/clinpract13040086
DO - 10.3390/clinpract13040086
M3 - Review article
AN - SCOPUS:85169020989
SN - 2039-7283
VL - 13
SP - 944
EP - 958
JO - Clinics and Practice
JF - Clinics and Practice
IS - 4
ER -