Advertisement

Single center experience transplanting kidneys from deceased donors with terminal acute renal failure

      Background

      Transplantation of kidneys from deceased donors with terminal acute renal failure (ARF) is uncommon.

      Methods

      We reviewed retrospectively our single-center experience with transplantation of ARF donor kidneys.

      Results

      From January 2007 through September 2008, we transplanted 25 kidneys from 17 ARF donors; 22 kidneys were from standard criteria donors. Mean donor age was 34 years. Mean admission and terminal donor serum creatinine values were 1.3 mg/dL and 3.1 mg/dL. All but 2 kidneys were placed on pump preservation; mean cold ischemia time was 27 hours. The recipient group had a mean age of 49 years and a mean waiting time of 24 months. Patient and graft survival rates were 100% and 92%, respectively, with a mean follow-up of 12 months. Delayed graft function occurred in 8 patients (32%), mean initial duration of stay was 6 days, 3 patients (12%) required re-operation, 3 patients (12%) had acute rejection, and 8 patients (32%) developed infections. Mean 1- and 12-month recipient serum creatinine and glomerular filtration rate values were 1.9 mg/dl (45 mL/min) and 1.5 mg/dl (50 mL/min), respectively.

      Conclusion

      Kidneys from deceased donors with terminal ARF have excellent short-term outcomes and represent another potential method to safely expand the donor pool.
      To read this article in full you will need to make a payment
      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • McCullough K.P.
        • Keith D.S.
        • Meyer K.H.
        • Stock P.G.
        • Brayman K.L.
        • Leichtman A.B.
        Kidney and pancreas transplantation in the United States, 1998-2007: access for patients with diabetes and end-stage renal disease.
        Am J Transplant. 2009; 9: 894-906
        • Tuttle-Newhall J.E.
        • Krishnan S.M.
        • Levy M.F.
        • McBride V.
        • Orlowski J.P.
        • Sung R.S.
        Organ donation and utilization in the United States: 1998-2007.
        Am J Transplant. 2009; 9: 879-893
        • Marks W.H.
        • Wagner D.
        • Pearson T.C.
        • Orlowski J.P.
        • Nelson P.W.
        • McGowan J.J.
        • et al.
        Organ donation and utilization, 1995-2004: entering the collaborative era.
        Am J Transplant. 2006; 6: 1101-1110
        • Stratta R.J.
        • Rohr M.S.
        • Sundberg A.K.
        • Farney A.C.
        • Hartmann E.L.
        • Moore P.S.
        • et al.
        Intermediate-term outcomes with expanded criteria deceased donors in kidney transplantation: a spectrum or specter of quality?.
        Ann Surg. 2006; 243: 594-601
        • Pascual J.
        • Zamora J.
        • Pirsch J.D.
        A systematic review of kidney transplantation from expanded criteria donors.
        Am J Kidney Dis. 2008; 52: 553-586
        • Farney A.C.
        • Singh R.P.
        • Hines M.H.
        • Rogers J.
        • Hartmann E.L.
        • Reeves-Daniel A.
        • et al.
        Experience in renal and extrarenal transplantation with donation after cardiac death donors with selective use of extracorporeal support.
        J Am Coll Surg. 2008; 206: 1028-1037
        • Howard R.J.
        • Schold J.D.
        • Cornell D.L.
        A 10-year analysis of organ donation after cardiac death in the United States.
        Transplantation. 2005; 80: 564-568
        • Schweitzer E.J.
        • Perencevich E.N.
        • Philosophe B.
        • Bartlett S.T.
        Estimated benefits of transplantation of kidneys from donors at increased risk for HIV or hepatitis C infection.
        Am J Transplant. 2007; 7: 1515-1525
        • Peters T.G.
        • Shaver T.R.
        • Ames J.E.
        IV, Santiago-Delpin EA, Jones KW, Blanton JW. Cold ischemia and outcome in 17,937 cadaveric kidney transplants.
        Transplantation. 1995; 59: 191-196
        • Moore P.S.
        • Farney A.C.
        • Sundberg A.K.
        • Rohr M.S.
        • Hartmann E.L.
        • Iskandar S.S.
        • et al.
        Experience with dual kidney transplants from donors at the extremes of age.
        Surgery. 2006; 140: 597-605
        • Al Khader A.A.
        • Shaheen F.A.
        • Attar B.A.
        • Elamin K.M.
        • Al Ghamdi F.
        • Jondeby M.
        Successful use of kidneys from deceased donors with acute renal failure.
        Prog Transplant. 2007; 17: 258-263
        • Greenstein S.M.
        • Moore N.
        • McDonough P.
        • Schechner R.
        • Tellis V.
        Excellent outcome using “impaired” standard criteria donors with elevated serum creatinine.
        Clin Transplant. 2008; 22: 630-633
        • Morgan C.
        • Martin A.
        • Shapiro R.
        • Randhawa P.S.
        • Kayler L.K.
        Outcomes after transplantation of deceased-donor kidneys with rising serum creatinine.
        Am J Transplant. 2007; 7: 1288-1292
        • Sohrabi S.
        • Navarro A.P.
        • Wilson C.
        • Sanni A.
        • Wyrley-Birch H.
        • Anand D.V.
        • et al.
        Donation after cardiac death kidneys with low severity pre-arrest acute renal failure.
        Am J Transplant. 2007; 7: 571-575
        • Anil Kumar M.S.
        • Khan S.M.
        • Jaglan S.
        • Heifets M.
        • Moritz M.J.
        • Saeed M.I.
        • et al.
        Successful transplantation of kidneys from deceased donors with acute renal failure: three-year results.
        Transplantation. 2006; 82: 1640-1645
        • Thomusch O.
        • Gerstenkorn C.
        • Boehm J.
        • Arldt T.
        • Hopt U.
        • Pisarski P.
        Successful transplantation of kidneys from a donor with myoglobinuric acute renal failure.
        Am J Transplant. 2006; 6: 2500-2501
        • Navarro A.P.
        • Sohrabi S.
        • Wilson C.
        • Sanni A.
        • Wyrley-Birch H.
        • Vijayanand D.
        • et al.
        Renal transplants from category III non-heart-beating donors with evidence of pre-arrest acute renal failure.
        Transplant Proc. 2006; 38: 2635-2636
        • Ugarte R.
        • Kraus E.
        • Montgomery R.A.
        • Burdick J.F.
        • Ratner L.
        • Haas M.
        • et al.
        Excellent outcomes after transplantation of deceased donor kidneys with high terminal creatinine and mild pathologic lesions.
        Transplantation. 2005; 80: 794-800
        • Lewers D.T.
        • Mathew T.H.
        • Maher J.F.
        • Schreiner G.E.
        Long-term follow-up of renal function and histology after acute tubular necrosis.
        Ann Intern Med. 1970; 73: 523-529
        • Dahmane D.
        • Audard V.
        • Hiesse C.
        • Pessione F.
        • Bentaarit B.
        • Barrou B.
        • et al.
        Retrospective follow-up of transplantation of kidneys from ‘marginal’ donors.
        Kidney Int. 2006; 69: 546-552
        • Stratta R.J.
        • Moore P.S.
        • Farney A.C.
        • Rogers J.
        • Hartmann E.L.
        • Reeves-Daniel A.
        • et al.
        Influence of pulsatile perfusion preservation on outcomes in kidney transplantation from expanded criteria donors.
        J Am Coll Surg. 2007; 204: 873-882
        • Sonnenday C.J.
        • Cooper M.
        • Kraus E.
        • Gage F.
        • Handley C.
        • Montgomery R.A.
        The hazards of basing acceptance of cadaveric renal allografts on pulsatile perfusion parameters alone.
        Transplantation. 2003; 75: 2029-2033
      1. United Network for Organ Sharing. National data. Available from URL: http://www.unos.org/data. Accessed February 9, 2009.

        • Kayler L.K.
        • Garzon P.
        • Magliocca J.
        • Fujita S.
        • Kim R.D.
        • Hemming A.W.
        • et al.
        Outcomes and utilization of kidneys from deceased donors with acute kidney injury.
        Am J Transplant. 2009; 9: 367-373
        • Perico N.
        • Cattaneo D.
        • Sayegh M.H.
        • Remuzzi G.
        Delayed graft function in kidney transplantation.
        Lancet. 2004; 364: 1814-1827
        • Port F.
        • Bragg-Gresham J.
        • Metzger R.
        • Dykstra D.M.
        • Gillespie B.W.
        • Young E.W.
        • et al.
        Donor characteristics associated with reduced graft survival: an approach to expanding the pool of kidney donors.
        Transplantation. 2002; 74: 1281-1286
        • Perico N.
        • Cattaneo D.
        • Sayegh M.H.
        • Remuzzi G.
        Delayed graft function in kidney transplantation.
        Lancet. 2004; 364: 1814-1827