Viability assessment and utilization of declined donor kidneys with rhabdomyolysis using ex vivo normothermic perfusion without preimplantation biopsy

Abstract

The role of ex vivo normothermic perfusion (EVNP) in both organ viability assessment and reconditioning is increasingly being demonstrated. We report the use of this emerging technology to facilitate the transplantation of a pair of donor kidneys with severe acute kidney injury (AKI) secondary to rhabdomyolysis. Donor creatinine was 10.18 mg/dl with protein (30 mg/dl) present in urinalysis. Both kidneys were declined by all other transplantation units and subsequently accepted by our unit. The first kidney was perfused with red cell‐based perfusate at 37°C for 75 min, mean renal blood flow was 110 ml/min/100 g and produced 85 ml of urine. Having demonstrated favorable macroscopic appearance and urine output, the kidney was transplanted into a 61‐year‐old peritoneal dialysis dependent without complication. Given the reassuring information from the first kidney provided by EVNP, the second kidney was not perfused with EVNP and was directly implanted to a 64‐year‐old patient. The first kidney achieved primary function and the second functioned well after delayed graft function. Recipient eGFR have stabilized at 88.5 and 55.3, respectively (ml/min/1.73 m2), at 2 months posttransplant.

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

“…Successful transplant of a kidney with severe acute kidney injury from rhabdomyolysis following effective warm perfusion has been reported. 70 A prospective trial of normothermic perfusion is currently under way to assess impacts on graft utilization and outcome. 71 Alternatively, hypothermic oxygenated perfusion can be performed.…”

Advances in Normothermic Machine Perfusion of the Kidney: Evidence for Clinical Practice and Underlying Mechanistic Actions

“…In most cases banked red cells are added as an oxygen carrier and various nutrients, amino acids/electrolytes and supplements added to support cellular metabolism and replenish ATP 10 . The evidence for NMP in clinical practice is limited to a small number of case series and several case reports [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . One randomised controlled trial (RCT) has recently been completed (results not yet published) 26 .…”