S. Bajpai1, W. C. Goggins1, R. S. Mangus1 1Indiana University School Of Medicine,Surgery / Transplant,Indianapolis, IN, USA
Introduction:
The use of contrast media in hospital procedures has been increasing since its initial use in 1923. Despite developments in utility and safety over time, contrast media has been associated with kidney injury in exposed patients. Several studies have investigated contrast-induced nephropathy (CIN) in hospital patients and kidney recipients post-transplant. However, there are few studies that connect kidney donor contrast exposure to kidney transplant recipient outcomes. This study reviews all deceased kidney donors at a single center over a 15-year period to determine if donor contrast exposure results in CIN in the donor, or is associated with delayed graft function or graft survival in the transplant recipient.
Methods:
The records of all deceased kidney transplants were reviewed. Donor initial, peak and last serum creatinine levels were recorded. Recipient renal function was recorded, including delayed graft function, creatinine clearance at one-year and 36 months graft survival. Donor contrast exposure was recorded and generally included computed tomography studies and angiograms. Contrast dosing was not available, so exposure was recorded as the number of contrasted studies received by the recipient.
Results:
The records of 1585 deceased donor kidney transplants were reviewed. Complete donor records were available for 1394 (88%). There were 51% of donors who received any contrast study (38% 1 study, 12% 2 studies, 1% 3 studies). Donor contrast exposure was not associated with any significant changes in donor pre-procurement serum creatinine levels. Post-transplant, donor contrast exposure was not associated with risk of delayed graft function (4% for all), nor with kidney graft survival at 7-, 30- or 90-days. Creatinine clearance at 1-year was equivalent for the study groups. Cox regression analysis demonstrated slightly higher graft survival at 36 months post transplant for donor grafts that were exposed to contrast (p=0.02).
Conclusion:
These results fail to demonstrate any negative effect of donor contrast administration on early and late kidney graft function in a large number of exposed patients over a long time period. These results included donor kidneys exposed to as many as 3 contrasted studies prior to graft procurement. Long term survival was higher in donor grafts exposed to any contrast. This finding may be related to more desirable donors undergoing more extensive pre-donation testing.
