Results of Kidney Transplantation From Deceased Donors With Acute Kidney Injury

Molina, María; Apaza, Jacqueline; Monte, Esther González; Martínez, E. Gutiérrez; Sevillano, Ángel; Marı́n, Jesús; Polanco, Natalia; Hernández, Ana; Praga, Manuel; Andrés, Amado

doi:10.1016/j.transproceed.2014.11.007

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…O estudo demonstra que a necessidade de diálise pós-transplante é mais elevada com o uso de enxertos renais de doadores com LRA, fato que não afeta os índices de rejeição ou função do enxerto em longo prazo. 9,10 Uma das causas de LRA é RB, síndrome caracterizada por disfunção muscular com ruptura do sarcolema e consequente estravazamento de creatina quinase (CK), creatinina e, principalmente, mioglobina para a corrente sanguínea. 11 A RB afeta quase 10% de todos os pacientes com LRA nos Estados Unidos, e pode ser causada por traumas, exercícios exacerbados, imobilização prolongada, uso de cocaína, choque elétrico e raramente por uso de estatina.…”

Section: Discussionunclassified

Uso De Enxertos Renais De Doadores Falecidos Com Lesão Aguda Por Rabdomiólise é Possível?

Marques

Mello

Miranda

et al. 2017

bjt

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Introdução: Transplante de rim (TR) é a terapêutica de escolha para doença renal terminal. A universal desproporção entre demanda para TR e doadores disponíveis exige o desenvolvimento de novas estratégias para aumento da oferta de enxertos renais. Entre estas, citam-se o aumento de TR intervivos e o uso de doadores falecidos com critérios expandidos (DCE). Enxertos com lesão renal aguda (LRA) representam uma das situações de DCE, e sua utilização persiste sendo tema controverso diante da incerteza da reversão da lesão renal pós-TR. Rabdomiólise (RB) é a causa de 7 a 10% dos enxertos com LRA e decorre da liberação de mioglobina na circulação e consequente lesão tubular por mecanismos diversos. Objetivos: Motivados por oferta recente de enxerto renal com RB e posterior não autorização de uso pela Organização de Procura de Órgãos, os autores objetivaram revisar a literatura sobre a viabilidade de TR de doador falecido com RB. Métodos: Revisão da literatura do banco de dados Medline usando descritores específicos, no período de 2000 a 2018. Resultados: Sete artigos demonstraram experiências com total de 51 TR de enxertos com RB. Dos 29 doadores com RB, 20,7% encontravam-se em hemodiálise no momento da doação e a mediana da creatinina era de 3,9 mg/dl. TR com doadores em RB apresentaram função retardada do enxerto em 35,3% dos casos, mas um mês após a cirurgia, os rins mostraram recuperação total e função normal, confirmadas por biópsia. Conclusão: Não há critérios brasileiros bem estabelecidos para uso de enxertos renais com RB, mas estudos atuais demonstram bons resultados e recuperação da função renal na grande maioria desses casos. Por enquanto, o aproveitamento de enxertos renais com RB deveria ficar a critério e julgamento de cada equipe.

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Section: Discussionunclassified

Uso De Enxertos Renais De Doadores Falecidos Com Lesão Aguda Por Rabdomiólise é Possível?

Marques

Mello

Miranda

et al. 2017

bjt

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“…This study reports all potential donor cases in a region of Australia, rather than the perspective of a single renal transplant unit and provides more detailed information on donor characteristics and selection compared to previous studies. 4,[6][7][8][9][10][11][12][13][14][15][16]27 This report therefore might assist organ procurement organizations and clinicians tasked with determining whether to proceed with donation and kidney procurement in potential organ donors with AKI.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…Most of these reports are from the perspective of renal transplant units and include donors with only mild forms of AKI or standard criteria donors (SCD) with brain death and provide limited information about donor characteristics or selection.…”

mentioning

confidence: 99%

“…The presence of acute kidney injury (AKI) in the deceased donor has been a relative contraindication to renal transplantation [4][5][6][7][8][9][10][11][12][13][14][15][16] and is associated with higher rate of kidney non-utilization. 17 This is despite the fact that studies of the epidemiology of AKI in the ICU suggest that renal recovery is likely in the absence of chronic renal disease.…”

mentioning

confidence: 99%

“…18 A number of previous studies of transplanting kidneys from donors with AKI report a high rate of delayed graft function but satisfactory longer-term transplant outcomes. 19,20 Most of these reports are from the perspective of renal transplant units [4][5][6][7][8][9][10][11][12][13][14][15][16] and include donors with only mild forms of AKI 4,6,7,9,10,13,16,20 or standard criteria donors (SCD) with brain death 4,5,11,15,16 and provide limited information about donor characteristics or selection.…”

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confidence: 99%

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Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy

et al. 2019

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Background Kidney transplantation is the preferred treatment for end‐stage renal failure. Unfortunately, donor organ shortages prevent many individuals receiving a renal transplant and there is a need to increase the pool of appropriate donors. The presence of acute kidney injury (AKI) in deceased donors has traditionally been a relative contraindication to renal transplantation, even though renal recovery may be favorable in the absence of chronic renal disease. Methods We undertook an 8 years retrospective observational study of potential deceased organ donors with AKI requiring renal replacement therapy (RRT). We evaluated the rate of successful transplantation as well as short term and outcomes at a median of 19.5 (13.0–52.7) months after donation. Results Amongst 1058 consented potential organ donors, 39 patients had AKI requiring RRT, of which 19 became donors (13 not medically suitable, 7 did not proceed to donation). The median (interquartile range (IQR)) donor age was 41 (34–50) years and norepinephrine, epinephrine and vasopressin were given to 18, 14 and 9 donors, respectively. From the 38 donated kidneys 34 were transplanted. The median (IQR) age of recipients was 53 (42.8–58.5) years and they were dialysis free in a median (IQR) of 5.5 (2.3–10.8) days. Only minor abnormalities were found at 3 and 6 months renal biopsies, and two patients experienced graft failure in the first 12 months. Conclusion Amongst deceased donors with AKI receiving RRT and vasoactive medications outcomes of renal transplantation seems acceptable in the absence of pre‐existing renal failure and other donor co‐morbidity. Such patients may be an important additional source of kidney donation.

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Kidney Transplant Outcomes From Deceased Donors Who Received Dialysis

Wen,

Mansour,

Srialluri

et al. 2024

JAMA

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ImportanceRecipient outcomes after kidney transplant from deceased donors who received dialysis prior to kidney donation are not well described.ObjectiveTo compare outcomes of transplant recipients who received kidneys from deceased donors who underwent dialysis prior to kidney donation vs recipients of kidneys from deceased donors who did not undergo dialysis.Design, Setting, and ParticipantsA retrospective cohort study was conducted including data from 58 US organ procurement organizations on deceased kidney donors and kidney transplant recipients. From 2010 to 2018, 805 donors who underwent dialysis prior to kidney donation were identified. The donors who underwent dialysis prior to kidney donation were matched 1:1 with donors who did not undergo dialysis using a rank-based distance matrix algorithm; 1944 kidney transplant recipients were evaluated.ExposureKidney transplants from deceased donors who underwent dialysis prior to kidney donation compared with kidney transplants from deceased donors who did not undergo dialysis.Main Outcomes and MeasuresThe 4 study outcomes were delayed graft function (defined as receipt of dialysis by the kidney recipient ≤1 week after transplant), all-cause graft failure, death-censored graft failure, and death.ResultsFrom 2010 to 2018, 1.4% of deceased kidney donors (805 of 58 155) underwent dialysis prior to kidney donation. Of these 805 individuals, 523 (65%) donated at least 1 kidney. A total of 969 kidneys (60%) were transplanted and 641 kidneys (40%) were discarded. Among the donors with kidneys transplanted, 514 (mean age, 33 years [SD, 10.8 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) underwent dialysis prior to donation and were matched with 514 (mean age, 33 years [SD, 10.9 years]; 98 had hypertension [19.1%] and 36 had diabetes [7%]) who did not undergo dialysis. Kidney transplants from donors who received dialysis prior to donation (n = 954 kidney recipients) were associated with a higher risk of delayed graft function compared with kidney transplants from donors who did not receive dialysis (n = 990 kidney recipients) (59.2% vs 24.6%, respectively; adjusted odds ratio, 4.17 [95% CI, 3.28-5.29]). The incidence rates did not significantly differ at a median follow-up of 34.1 months for all-cause graft failure (43.1 kidney transplants per 1000 person-years from donors who received dialysis prior to donation vs 46.9 kidney transplants per 1000 person-years from donors who did not receive dialysis; adjusted hazard ratio [HR], 0.90 [95% CI, 0.70-1.15]), for death-censored graft failure (22.5 vs 20.6 per 1000 person-years, respectively; adjusted HR, 1.18 [95% CI, 0.83-1.69]), or for death (24.6 vs 30.8 per 1000 person-years; adjusted HR, 0.76 [95% CI, 0.55-1.04]).Conclusions and RelevanceCompared with receiving a kidney from a deceased donor who did not undergo dialysis, receiving a kidney from a deceased donor who underwent dialysis prior to kidney donation was associated with a significantly higher incidence of delayed graft function, but no significant difference in graft failure or death at follow-up.

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Results of Kidney Transplantation From Deceased Donors With Acute Kidney Injury

Cited by 14 publications

References 13 publications

Uso De Enxertos Renais De Doadores Falecidos Com Lesão Aguda Por Rabdomiólise é Possível?

Uso De Enxertos Renais De Doadores Falecidos Com Lesão Aguda Por Rabdomiólise é Possível?

Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy

Kidney Transplant Outcomes From Deceased Donors Who Received Dialysis

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