Renal transplants from non‐heart beating paracetamol overdose donors

Gok, Muhammed A.; Gupta, Ajay; Olschewski, Peter; Bhatti, Aftab; Shenton, B. K.; Robertson, Helen Lee; Soomro, Naeem; Talbot, David

doi:10.1111/j.1399-0012.2004.00207.x

Cited by 9 publications

(3 citation statements)

References 32 publications

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“…It has been hypothesized that a locally produced metabolite induces proximal tubular cell necrosis while functional renal effects may also contribute (33,35,36). Our findings support the reversibility of acetaminophen‐induced nephrotoxicity (37,38).…”

Section: Discussionsupporting

confidence: 83%

Chronic Kidney Disease After Liver Transplantation for Acute Liver Failure Is Not Associated With Perioperative Renal Dysfunction

Leithead

Ferguson

Bates

et al. 2011

American Journal of Transplantation

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Section: Discussionsupporting

confidence: 83%

Chronic Kidney Disease After Liver Transplantation for Acute Liver Failure Is Not Associated With Perioperative Renal Dysfunction

Leithead

Ferguson

Bates

et al. 2011

American Journal of Transplantation

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“…However, according to 2015 data from 28 states with high-quality reporting, 63% of overdose deaths involved opioids (2). Moreover, use of organs for transplant after death due to other types of chemical poisoning is rare (43, 44). We could not determine the specific behavior for which ODDs were labeled as IRDs, and behaviors may differ between TDDs and MDDs who are labeled as IRDs.…”

Section: Discussionmentioning

confidence: 99%

The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States

et al. 2018

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Background: The epidemic of drug overdose deaths in the United States has led to an increase in organ donors. Objective: To characterize donors who died of overdose and to analyze outcomes among transplant recipients. Design: Prospective observational cohort study. Setting: Scientific Registry of Transplant Recipients, 1 January 2000 to 1 September 2017. Participants: 138 565 deceased donors; 337 934 transplant recipients at 297 transplant centers. Measurements: The primary exposure was donor mechanism of death (overdose-death donor [ODD], trauma-death donor [TDD], or medical-death donor [MDD]). Patient and graft survival and organ discard (organ recovered but not transplanted) were compared using propensity score-weighted standardized risk differences (sRDs). Results: A total of 7313 ODDs and 19 897 ODD transplants (10 347 kidneys, 5707 livers, 2471 hearts, and 1372 lungs) were identified. Overdose-death donors accounted for 1.1% of donors in 2000 and 13.4% in 2017. They were more likely to be white (85.1%), aged 21 to 40 years (66.3%), infected with hepatitis C virus (HCV) (18.3%), and increased-infectious risk donors (IRDs) (56.4%). Standardized 5-year patient survival was similar for ODD organ recipients compared with TDD organ recipients (sRDs ranged from 3.1% lower to 3.9% higher survival) and MDD organ recipients (sRDs ranged from 2.1% to 5.2% higher survival). Standardized 5-year graft survival was similar between ODD and TDD grafts (little difference for kidneys and lungs, marginally lower [sRD, −3.2%] for livers, and marginally higher [sRD, 1.9%] for hearts). Kidney discard was higher for ODDs than TDDs (sRD, 5.2%) or MDDs (sRD, 1.5%); standardization for HCV and IRD status attenuated this difference. Limitation: Inability to distinguish between opioid and nonopioid overdoses. Conclusion: In the United States, transplantation with ODD organs has increased dramatically, with noninferior outcomes in transplant recipients. Concerns about IRD behaviors and hepatitis C among donors lead to excess discard that should be minimized given the current organ shortage.

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“…MP may reduce the DGF of grafts retrieved from heart-beating donors and donation after cardiac death (DCD) donors by 20% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Many authors have reported on the beneficial effects of MP on organs from marginal and DCD donors (33)(34)(35)(36)(37). Reports on renal allograft function in relation to preservation mode have focused on observations up to 12 months post-transplant (38)(39)(40)(41)(42) or have applied statistical simulation based on the relationship between function and graft survival and DGF (43)(44)(45)(46)(47) or the relationship between DGF and acute rejection (48).…”

Section: Discussionmentioning

confidence: 99%

Machine Perfusion Preservation Improves Renal Allograft Survival

Kwiatkowski

Wszoła

Kosieradzki

et al. 2007

American Journal of Transplantation

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Machine perfusion (MP) has been used as the kidney preservation method in our center for over 10 years. The first, small (n = 74) prospective, single-blinded randomized study comparing MP and Cold Storage (CS) showed that the incidence of delayed graft function was higher after CS. There have been no reports in the literature on the effect of storage modality on longterm function of renal allografts. This paper presents an analysis of long-term results of renal transplantation in 415 patients operated on between 1994 and 1999. Of those, 227 kidneys were MP-stored prior to KTx. The control group consisted of 188 CS kidney transplants. Kidneys were not randomized to MP or to CS. Donor demographics, medical and biochemical data, cold ischemia time, HLA match and recipient data were collected. Standard triple-drug immunosuppression was administered to both groups. Mortality, graft survival and incidence of return to hemodialysis treatment were analyzed. Despite longer cold ischemia time and poorer donor hemodynamics in MP group, 5-year Kaplan-Meier graft survival was better in MP-stored than in CS-stored kidneys (68.2% vs. 54.2%, p = 0.02). Conclusion: In this nonrandomized analysis, kidney storage by MP improved graft survival and reduced the number of patients who returned to dialysis.

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Renal transplants from non‐heart beating paracetamol overdose donors

Cited by 9 publications

References 32 publications

Chronic Kidney Disease After Liver Transplantation for Acute Liver Failure Is Not Associated With Perioperative Renal Dysfunction

Chronic Kidney Disease After Liver Transplantation for Acute Liver Failure Is Not Associated With Perioperative Renal Dysfunction

The Drug Overdose Epidemic and Deceased-Donor Transplantation in the United States

Machine Perfusion Preservation Improves Renal Allograft Survival

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