J Korean Soc Transplant.  2015 Dec;29(4):233-237. 10.4285/jkstn.2015.29.4.233.

Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy

• Lee JY
• Kim YH
• Kwon HW
• Choi JY
• Shin S
• Jung JH
• Hong JJ
• Han DJ

• KMID: 2202609
• DOI: http://doi.org/10.4285/jkstn.2015.29.4.233

Abstract

BACKGROUND
Brain death donors may require continuous renal replacement therapy (CRRT) in severe acute renal failure (ARF) during management. To maximize donor organ usage we performed renal transplantation from deceased donors requiring CTTR with informed consent. This single-center study reviewed the clinical outcomes of kidney transplant recipients from extreme marginal donors requiring CRRT.
METHODS
Medical records of all patients using a graft from extreme marginal donors who underwent CRRT in Asan Medical Center between June 2007 and September 2014 were reviewed retrospectively.
RESULTS
Between June 2007 and September 2014, 27 kidneys were transplanted from 19 CRRT donors. Mean donor age was 35.1 years (range; 16~56), male donors were 14 (74%). The causes of brain death included head trauma in 6, hypoxia in 5, stroke in 4, and others in 4. The main causes of CRRT were anuria in 14, electrolyte imbalance or acidosis in 5, and mean duration of donor CRRT was 3.6 days (range; 1~11). Delayed graft function (DGF) developed in 24 (88.9%), but all recovered renal function; they can be free from dialysis 11 days after transplantation. Mean serum creatinine level at 1 month, 1 year, and 5 years was 1.85, 1.26, and 1.31 mg/dL, respectively.
CONCLUSIONS
Five-year follow-up data showed that renal transplantation from severe ARF donor has an excellent outcome. Although CRRT donor kidney transplants have a higher rate of DGF, the presence of DGF, unlike other donation after brain death donor kidney transplants, does not portend a worse prognosis.

Keyword

Kidney transplantation; Expanded criteria donor; Acute kidney injury; Continuous renal replacement therapy

MeSH Terms

Acidosis
Acute Kidney Injury
Anoxia
Anuria
Brain Death
Chungcheongnam-do
Craniocerebral Trauma
Creatinine
Delayed Graft Function
Dialysis
Follow-Up Studies
Humans
Informed Consent
Kidney Transplantation*
Kidney*
Male
Medical Records
Prognosis
Renal Replacement Therapy
Retrospective Studies
Stroke
Tissue Donors*
Transplantation
Transplants
Creatinine

Figure

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  Fig. 1. Serum creatinine in all recipients (n=27). Serum creatinine of all recipients during follow up mean 3.8 years (range; 0.9∼8.1). one patient died from donor derived scedosporium infection (post transplant 58th day).

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  Fig. 2. The mean serum creatinine of two group (continuous renal replacement therapy [CRRT] donor vs. standard criteria donor [SCD]). Each groups showed no significant difference finally. In the first month after transplantation, the CRRT group showed higher serum creatinine level due to high rate of delayed graft function.

Reference

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