Transplant of Kidneys from a Small Pediatric Donor with Severe Rhabdomyolysis

Phair, John P.; Kayler, Liise K.

doi:10.1097/tp.0b013e3182a289db

Cited by 5 publications

(10 citation statements)

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“…Rhabdomyolysis and acute renal failure (ARF) may be considered a contraindication for kidney donation, especially when the donor is anuric . There are a few case reports in the literature of kidney transplantation from donors with rhabdomyolysis, but the long‐term renal function of these grafts is unknown . Here, we report our initial experience of kidney transplantation from donors with severe rhabdomyolysis and ARF.…”

Section: Introductionmentioning

confidence: 99%

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Kidney transplantation from donors with rhabdomyolysis and acute renal failure

Chen

Zheng

Zhou

et al. 2017

Clinical Transplantation

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Rhabdomyolysis in deceased donors usually causes acute renal failure (ARF), which may be considered a contraindication for kidney transplantation. From January 2012 to December 2016, 30 kidneys from 15 deceased donors with severe rhabdomyolysis and ARF were accepted for transplantation at our center. The peak serum creatinine (SCr) kinase, myoglobin, and SCr of the these donors were 15 569±8597 U/L, 37 092±42 100 μg/L, and 422±167 μmol/L, respectively. Two donors received continuous renal replacement therapy due to anuria. Six kidneys exhibited a discolored appearance (from brown to glossy black) due to myoglobin casts. The kidney transplant results from the donors with rhabdomyolysis donors were compared with those of 90 renal grafts from standard criteria donors (SCD). The estimated glomerular filtration rate at 2 years was similar between kidney transplants from donors with rhabdomyolysis and SCD (70.3±14.6 mL/min/1.73 m vs 72.3±15.1 mL/min/1.73 m ). We conclude that excellent graft function can be achieved from kidneys donors with ARF caused by rhabdomyolysis.

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Section: Introductionmentioning

confidence: 99%

“…8,9 There are a few case reports in the literature of kidney transplantation from donors with rhabdomyolysis, but the long-term renal function of these grafts is unknown. [9][10][11][12][13] Here, we report our initial experience of kidney transplantation from donors with severe rhabdomyolysis and ARF.…”

Section: Introductionmentioning

confidence: 99%

Kidney transplantation from donors with rhabdomyolysis and acute renal failure

Chen

Zheng

Zhou

et al. 2017

Clinical Transplantation

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“…4,6 Descrevem-se também outras causas como afogamento, desidratação e sepse. 12 A fisiopatologia da RB envolve ruptura de células musculares e liberação de mioglobina, que pode causar danos aos rins por diversos mecanismos. O aumento dos níveis de mioglobina e sua precipitação nos túbulos causa obstrução do lúmen e reduz a filtração glomerular.…”

Section: Discussionunclassified

“…6,14,15 Muitos estudos concordam e demonstram que LRA e RB não deveriam ser contraindicação para doação renal. 6,12,14 Mesmo que os pacientes possam apresentar função tardia do enxerto, após um mês de TR os enxertos geralmente demonstram total recuperação e função normal, confirmadas por biópsia. 9,14 Portanto, os resultados mostram-se promissores e representam boa opção para ampliar o pool de doadores.…”

Section: Discussionunclassified

“…6 Fernanda Folla Pompeu Marques, Tiago Genzini de Miranda, Emanuela Yumi Fugisawa de Mello, Natallia Meira Gonsalez, Isabela Pereira Blanco, Marcio Paredes, Leon Alvim, David Machado, Celia Watanabe, Francisco Sergi, Juan Branez, Marcelo Perosa O uso da MP ocorreu em três dos sete artigos revisados. 6,12,15 Estabeleceu-se que ela confere melhor e mais rápida função do enxerto quando comparada à preservação estática, devido, provavelmente, ao fato de remover os metabólitos tóxicos e eliminar cristais de mioglobina nos rins a serem transplantados.…”

Section: Discussionunclassified

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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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Short- and Long-term Outcomes of Kidney Transplants From Very Small (≤15 kg) Pediatric Donors With Acute Kidney Injury

et al. 2020

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Background. Kidneys from small deceased pediatric donors with acute kidney injury (AKI) are commonly discarded owing to transplant centers’ concerns regarding potentially inferior short- and long-term posttransplant outcomes. Methods. We retrospectively analyzed our center’s en bloc kidney transplants performed from November 2007 to January 2015 from donors ≤15 kg into adult recipients (≥18 y). We pair-matched grafts from 27 consecutive donors with AKI versus 27 without AKI for donor weight, donation after circulatory death status, and preservation time. Results. For AKI versus non-AKI donors, median weight was 7.5 versus 7.1 kg; terminal creatinine was 1.7 (range, 1.1–3.3) versus 0.3 mg/dL (0.1–0.9). Early graft loss rate from thrombosis or primary nonfunction was 11% for both groups. Delayed graft function rate was higher for AKI (52%) versus non-AKI (15%) grafts (P = 0.004). Median estimated glomerular filtration rate was lower for AKI recipients only at 1 and 3 months (P < 0.03). Graft survival (death-censored) at 8 years was 78% for AKI versus 77% for non-AKI grafts. Late proteinuria rates for AKI versus non-AKI recipients with >4 years follow-up were not significantly different. Conclusions. Small pediatric donor AKI impacted early posttransplant kidney graft function, but did not increase risk for early graft loss and decreased long-term function. The presently high nonutilization rates for en bloc kidney grafts from very small pediatric donors with AKI appear therefore unjustified. Based on the outcomes of the present study, we infer that the reluctance to transplant single kidneys from larger pediatric donors with AKI lacks a rational basis as well. Our findings warrant further prospective study and confirmation in larger study cohorts.

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Transplant of Kidneys from a Small Pediatric Donor with Severe Rhabdomyolysis

Cited by 5 publications

References 4 publications

Kidney transplantation from donors with rhabdomyolysis and acute renal failure

Kidney transplantation from donors with rhabdomyolysis and acute renal failure

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

Short- and Long-term Outcomes of Kidney Transplants From Very Small (≤15 kg) Pediatric Donors With Acute Kidney Injury

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