Background: The limited supply of deceased donors for renal transplantation led to considering alternative strategies for making more organs available. One of these strategies is the use of donors with renal dysfunction, as this is usually a reversible condition. RIFLE (risk, injury, failure, loss and end-stage renal failure) criteria were developed to standardize the definition and severity of acute kidney injury (AKI) but have not been previously used in brain-deceased donors. We applied the RIFLE classification to evaluate renal function changes in our donor pool, in an attempt to know its influence in transplant outcome.
Methods: Data were collected from the renal transplant patient and the intensive care unit brain-dead donors prospectively maintained databases of our hospital. Risk was defined when creatinine increased x1.5, injury when it increased x2 and failure when last creatinine increased x3 with respect to admission-day creatinine.
Results: From 176 donors, 10.8% suffered AKI and 7.9% were included in 'risk', 2.3% in 'injury' and 0.6% in 'failure' categories. There were no significant differences between AKI and non-AKI groups in donor and intensive care management variables, except in last-day creatinine. First-day urine volumes were lower (P = 0.043) and delayed graft function rates were higher (P = 0.013) in the AKI group than in the non-AKI group recipients. Graft survival and other outcome variables were not different between AKI and non-AKI recipients.
Conclusions: The RIFLE classification system offers us an opportunity to standardize and quantify renal injury in donors. Although >10% of brain-deceased donors can suffer AKI, these grafts can perform adequately. Hence, the development of AKI in donors cannot be an isolated criterion to discard kidney donation.