Not transplanting kidney donors with acute kidney injury: a missed opportunity?

Murakami, Naoka; Riella, Leonardo V.

doi:10.1590/2175-8239-jbn-2019-0194

Cited by 1 publication

(1 citation statement)

References 9 publications

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“…Multiple studies have shown that kidneys that suffered AKI after brain death can be transplanted with good short and long-term outcomes. [2][3][4][5][10][11][12][13][14][15][16] Using the acute kidney injury network (AKIN) criteria, most of these studies have a low percentage of kidneys with Stage 3 AKI, rarely do they include kidneys requiring CRRT, 17 and the timing of CRRT initiation and outcomes of kidneys from donors treated with CRRT were not specifically reported. In a single center study in Germany over 11 years, 263 kidneys with AKI were transplanted but only ten received CRRT, and it is unclear when the CRRT was started.…”

Section: Discussionmentioning

confidence: 99%

The benefits of initiating continuous renal replacement therapy after brain death in organ donors with oligoanuric acute kidney injury

Marklin¹,

Ewald²,

Klinkenberg³

et al. 2022

Clinical Transplantation

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Acute kidney injury (AKI) in deceased organ donors is increasing due to the escalation in anoxic brain‐deaths. The management of an organ donor with oligoanuric AKI is frequently curtailed due to hemodynamic and electrolyte instability. Although continuous renal replacement therapy (CRRT) corrects the effects of AKI, it is rarely started after the diagnosis of brain‐death (BD). Since 2017, we have initiated CRRT in organ donors with oligoanuric AKI to allow more time to stabilize the donor and improve the function of the thoracic organs. We now report our experience with the first 27 donors with oligoanuric AKI that received CRRT after the diagnosis of BD, with organs transplanted as the primary outcome. The average duration of CRRT was 30.1 ± 14.4 h and the mean ultrafiltration volume was 5141 ± 4272 ml. The time from BD declaration to cross clamp was significantly longer in the CRRT group versus a historical cohort with oligoanuric AKI that was not dialyzed (62.8 ± 18.3 vs. 37.1 ± 14.9 h; P < .01). The mean number of total organs transplanted per donor in the CRRT group was greater than the historical cohort, 2.9 ± 1.7 vs. 1.4 ± .6 (P = .< 01), respectively. The mean number of thoracic organs transplanted per donor also increased between the two groups, 1.4 ± 1.2 versus .6 ± .9 (P = .02). Thirty‐seven percent of the kidneys were successfully transplanted with a mean serum creatinine of 1.4 mg/dl at 6 months. We suggest that OPOs consider starting CRRT in organ donors with oligoanuric AKI to possibly increase the number of organs transplanted.

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