The use of contrast media in deceased kidney donors does not affect initial graft function or graft survival

Abstract

Patients receiving cadaveric kidney transplants often experience delayed graft function. As iodinated contrast media injection (ICMI), necessary for cerebral angiography, which is often used to diagnose brain death, can be nephrotoxic, we compared renal function recovery (RFR) and 1-year and long-term graft survival according to the method used to diagnose brain death. Data from 9921 cadaveric kidneys, transplanted between 1 January 1998 and 31 December 2003, were retrieved from the French National Registry for organ donation. We defined RFR as the number of days for the recipient to reach a plasma creatinine less than 250 mumol/l, and/or a 24-h urine output greater than 1000 ml. RFR and 1-year and long-term graft survival were compared between four different donor groups (according to ICMI and diabetes mellitus). A total of 41.5% of deceased donors received ICMI before organ procurement and 1.95% of them were diabetic. History of ICMI or diabetes in the donor did not influence RFR or 1-year graft survival. Long-term graft survival was decreased in the group of patients transplanted with a diabetic graft as compared to patients transplanted with a non-diabetic graft (P=0.001). History of ICMI in the donor did not affect long-term graft survival in the non-diabetic donor group (P=0.2); however, in the diabetic group, ICMI tended to decrease long-term graft survival (P=0.056). ICMI did not affect RFR or graft survival in non-diabetic deceased donors. However, its use in diabetic deceased donors requires further study.

Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography

“…The latter is considered a risk factor for impaired kidney function, although it has been reported that the use of contrast causes no nephrological damage that could invalidate the use of the kidney for transplant [35].…”

“…It may be also useful when considering organ donation since it avoids delays in managing the potential donor. Although the patients included in our study were not sedated, their lack of CBF precludes the possibility of any neurological activity such that this criterion of a confirmed lack of blood flow in the brain will always determine an unequivocal diagnosis of brain death even in sedated patients [22,35].…”

Management of the Potential Organ Donor in the ICU

“…No significant increase in the prevalence of delayed graft function or reduction in graft survival has been associated with perimortem donor contrast studies (257,269,270).…”

Outcomes of Endovascular Aortic Aneurysm Repair in Kidney Transplant Recipients: Results From a National Quality Initiative

“…The current recommendations are to keep the administered contrast to a minimum, which is nonspecific (13,14). Park et al described the use of iodinated contrast:estimated glomerular filtration rate (eGFR) ratio for predicting contrast-induced acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention for myocardial infarction (15), but to date this metric has not been evaluated within the KTR population.…”