Single center experience transplanting kidneys from deceased donors with terminal acute renal failure

Zuckerman, Jack M.; Singh, Rajinder; Farney, Alan C.; Rogers, Jeffrey; Stratta, Robert J.

doi:10.1016/j.surg.2009.06.036

Cited by 32 publications

(78 citation statements)

References 25 publications

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“…However, in the last 10 years, case reports and large case series have been published and clinical practice has been changing, i.e., AKI kidneys from wellselected DBDs can successfully be used for transplantation [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Specifically, two recent large studies deserve to be highlighted.…”

Section: Introductionmentioning

confidence: 99%

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

et al. 2015

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“…Its introduction in the late nineteen eighties has reduced the incidence of delayed graft function (DGF) and improved graft survival of kidneys obtained from donations after brain death [2]. Nevertheless, the growing use of expanded criteria donors (ECD), donors with acute renal failure [3,4] and deceased after cardiac death donors (DCD) has increased the DGF incidence of graft preserved by UW [5] or by CS in general [6,7]. …”

Section: Introductionmentioning

confidence: 99%

Analysis of machine perfusion benefits in kidney grafts: a preclinical study

et al. 2011

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BackgroundMachine perfusion (MP) has potential benefits for marginal organs such as from deceased from cardiac death donors (DCD). However, there is still no consensus on MP benefits. We aimed to determine machine perfusion benefits on kidney grafts.MethodsWe evaluated kidney grafts preserved in ViaspanUW or KPS solutions either by CS or MP, in a DCD pig model (60 min warm ischemia + 24 h hypothermic preservation). Endpoints were: function recovery, quality of function during follow up (3 month), inflammation, fibrosis, animal survival.ResultsViaspanUW-CS animals did not recover function, while in other groups early follow up showed similar values for kidney function. Alanine peptidase and β-NAG activities in the urine were higher in CS than in MP groups. Oxydative stress was lower in KPS-MP animals. Histology was improved by MP over CS. Survival was 0% in ViaspanUW-CS and 60% in other groups. Chronic inflammation, epithelial-to-mesenchymal transition and fibrosis were lowest in KPS-MP, followed by KPS-CS and ViaspanUW-MP.ConclusionsWith ViaspanUW, effects of MP are obvious as only MP kidney recovered function and allowed survival. With KPS, the benefits of MP over CS are not directly obvious in the early follow up period and only histological analysis, urinary tubular enzymes and red/ox status was discriminating. Chronic follow-up was more conclusive, with a clear superiority of MP over CS, independently of the solution used. KPS was proven superior to ViaspanUW in each preservation method in terms of function and outcome. In our pre-clinical animal model of DCD transplantation, MP offers critical benefits.

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“…Our study included a broad cohort of both standard and expanded criteria donors. Most reports of transplanting kidneys with AKI focus on young, standard criteria donors who have otherwise excellent kidney donor characteristics . A common finding is of an increased incidence of delayed graft function, but similar short and intermediate term graft function and survival compared with standard criteria donors without AKI.…”

Section: Discussionmentioning

confidence: 99%

“…Our report also included a broad cohort of donors including DCD as well as DBD donors whereas the majority of previous studies have included only DBD donors . DCD is known to be associated with an increased incidence of delayed graft function.…”

Section: Discussionmentioning

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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Single center experience transplanting kidneys from deceased donors with terminal acute renal failure

Cited by 32 publications

References 25 publications

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

Excellent graft and patient survival after renal transplantation from donors after brain death with acute kidney injury: a case–control study

Analysis of machine perfusion benefits in kidney grafts: a preclinical study

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

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