Korean J Transplant.  2022 Sep;36(3):231-235. 10.4285/kjt.22.0033.

The significance of the first living donor kidney transplantation in Jeju: a case report

• Shin YH
• Lee T
• Chang WB

• KMID: 2533962
• DOI: http://doi.org/10.4285/kjt.22.0033

Abstract

To overcome the shortage of kidney donors, diverse methods have been utilized, in-cluding living donor kidney transplantation (LDKT) and extended criteria for deceased donor grafts. Currently, LDKT is a major treatment option. However, in Jeju, deceased donor kidney transplantation (DDKT) has been restricted due to the prolonged cold ischemia time (CIT) caused by the island’s geographic disadvantages and transportation limitations. We report the first LDKT in Jeju, which demonstrates a means of over-coming prolonged CIT. A 67-year-old male patient with diabetic nephropathy underwent a preemptive ABO compatible LDKT (ABO type O+) from his 62-year-old wife. The op-eration was uneventful, using anti-thymocyte globulin based on the recipient’s medical and immunologic risks. The patient recovered without significant complications and was discharged on postoperative day 15. Follow-up Doppler ultrasonography showed good blood flow to the kidney, and his serum creatinine levels steadily decreased and remained stable. The first successful LDKT in Jeju was significant in that kidney transplantation was implemented by compensating for its geographic limitations. In addition, we review machine perfusion as another method of avoiding prolonged CIT.

Keyword

Living donors; Kidney transplantation; Cold ischemia; Perfusion

Figure

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  Fig. 1 Three-dimensional computed tomography of the donor. A single artery was confirmed in each kidney.

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  Fig. 2 Preoperative and postoperative creatinine levels and urine outputs of the recipient. The serum creatinine level decreased in the first 2 days after transplantation and then remained stable. PrOD, preoperative day; POD, postoperative day; POM, postoperative month.

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  Fig. 3 (A) Kidney Doppler ultrasonography on postoperative day 8 showing good vascular flow within the normal range of the resistive index (RI, 0.81). (B) Follow-up kidney Doppler ultrasonography 2 months after surgery showing good intra- and extra-renal arterial flow with an RI within the normal range (0.76).

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  Fig. 4 A current commercial model of a portable hypothermic perfusion machine (LifePort Kidney Transporter, Itasca, IL, USA). (A) Insulation preserves a low temperature (4°C) and there is a static cold storage backup for safety. (B) A kidney maintaining a continuous flow using a modified University of Wisconsin solution.

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