Many renal transplantation centers arbitrarily deny transplantation to patients with morbid obesity usually defined as body mass index > 35. We present a series of 173 primary renal transplant patients in a new transplant program that accepted all recipients with 3 yrs or greater life expectancy and no active malignancy or infection. When the patient outcomes are divided into groups by body mass index, it can be seen as expected that patients with body mass index > 30 have an increased prevalence of wound infections (p < 0.05). However, aside from this complication there are no statistically significant outcome differences between the three groups realizing the possibility of type II statistical error because of small numbers. Graft survival, patient survival and other surgical complications are the same in all groups regardless of body mass index. At the end of the 3-yr interval with a minimum transplant follow-up of 3 months, 169 of 173 patients were alive and 163 of 173 transplants were functioning. Based on our experience, morbid obesity should not be used to exclude patients arbitrarily from transplantation anymore than advanced age or diabetes should.

Obese patients are denied renal transplantation in many centers. We report results regarding obesity from a new transplant program (1999 through 2007). Six hundred and forty-two patients were transplanted: 439 patients with BMI < 30 (Group 1), 109 patients with BMI 30.1-34.9 (Group 2), and 89 patients with BMI > 35 (Group 3). Follow-up was at least one yr. Medical and surgical management was performed by the same team throughout the study period. There were no demographic differences between groups except for increased diabetes in Groups 2 and 3. Actuarial graft and patient survivals were not statistically different between groups. Group 3 patients had numerical trends toward more delayed graft function and lower graft survivals but these did not reach statistical significance. Biopsy-proven rejections did not differ between groups. Wound infections were statistically significant in Groups 2 and 3 compared to Group 1 (p < 0.01). Despite increased wound infection rates with increased BMI, transplanting patients with morbid obesity results in better survival for individual patients than dialysis. Thus, there is no a priori ethical reason for treating obese ESRD patients differently from those with other comorbidities.

Naegleria fowleri is a free-living amebic organism that causes acute meningoencephalitis and brain death in young people. Though this infection is limited to the central nervous system, organ donation is usually ruled out because of the infectious nature of the donor's death. Based on the realization that this organism is limited to the brain, we successfully transplanted organs from a 12-year-old male donor dying of N. fowleri infection. Kidneys, pancreas, a lung and liver were used with no evidence of posttransplant infectious complications. This unusual cause of brain death does not preclude successful organ donation. Naegleria fowleri is a free-living ameba parasite. It is designated free-living because it can survive and replicate without requiring a host. This organism is found worldwide usually in bodies of water with relatively high temperatures. In endemic areas the organism can rarely be isolated from healthy individuals and such individuals often have antibodies to the organism (1). Occasionally (about 100 cases in the United States) a devastating rapidly fatal primary amebic meningoencephalitis occurs in children and young adults with a history of diving into lakes, ponds or swimming pools that have not been adequately chlorinated. The organism presumably gains access to the central nervous system via the olfactory epithelium, migrates to the cribiform plate then entering the brain. The incubation period between exposure and clinical manifestation varies from 1 day to 1 week. The patient presents with headache, fever, stiff neck and nausea and vomiting. Progressive neurological deterioration, coma and death occur within a few days in 95% of cases. The cause of death is brain herniation usually due to increased intra-cranial pressure (2). There are no reports of extra-CNS infections with this agent.In the past few years, increased numbers of cases have been reported from Florida, Texas and Arizona. Because of the infectious nature of the death, organs have been thought to be unusable for transplantation. There is one prior case of such organs being used prior to knowing the Naegleria diagnosis (3).We report a case of a 12-year-old male donor in Texas who had confirmed N. fowleri infection. The pre-mortem diagnosis was made based on motile amoebae in cerebrospinal fluid and confirmed by the Texas State Parasitology Laboratory. The organs were offered to multiple local and national transplant centers. Because of the perceived risk of infection for potential recipients, the offers were declined. Based on the epidemiology of N. fowleri infection as an exclusively central nervous system infection without systemic manifestations, we accepted both kidneys at our center. After informed consent by the transplant physicians from both patients, the kidneys were transplanted into a 29-year-old male with severe malignant hypertension and a 46-year-old male with IgA nephropathy. Despite cold ischemia times of 36 and 39 h, the kidneys functioned promptly and at 180 days posttransplant had serum creatinines of 1.2 an...

It has been controversial whether or not to accept kidneys for transplantation from donors with disseminated intravascular coagulation (DIC). We report two recipients who received the kidneys from a donor with DIC following traumatic head injury. Despite evidence of donor kidney glomerular fibrin deposits and ongoing low-grade DIC in the recipients, which resolved after 5-7 days; both recipients did well suggesting that donors with DIC can be successfully used for renal transplantation.

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