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Collini A, Piccioni S, Lorenz EM, Borgogni V, Ruggieri G, Carmellini M. Long-Term Function of Kidneys From an Acute Renal Failure Donor on Continuous Venovenous Hemofiltration: A Case Report. Transplant Proc 2020; 52:1611-1616. [PMID: 32253001 DOI: 10.1016/j.transproceed.2020.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 10/24/2022]
Abstract
The organ shortage has induced many transplant centers to use suboptimal grafts, such as those from expanded criteria donors and donors after cardiac death. Acute renal failure donors, sometimes present in intensive therapy units, have been used in a very low number of cases due to the fear of primary nonfunction of this type of graft. There are few published studies about the utilization of donors with severe acute renal failure and there is no general consensus identifying unequivocal criteria for their use by different transplant centers. We transplanted 2 kidneys from a 67-year-old donor who suffered from acute renal failure as a consequence of extracorporeal circulation in cardiac surgery and died of a massive cerebral edema with cistern obliteration. The kidneys were discarded by other transplant centers due to the patient's acute renal failure, treated by continuous venovenous hemofiltration. Both transplants were successful and both grafts showed very good renal function after 6 months. One recipient suffered from delayed graft function and renal drug toxicity, which resolved 1 month post transplant. The long-term graft function at 10 years is acceptable, with very low proteinuria. As a growing gap between the inadequate supply and constantly high demand for kidney transplantation has led doctors to explore novel policies to increase the number of available organs over the last 2 decades, acute renal failure treated by continuous venovenous hemofiltration does not seem to be a contraindication for the utilization of grafts.
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Affiliation(s)
- Andrea Collini
- Renal Transplant Center, Siena University Hospital, Siena, Italy.
| | | | | | - Vanessa Borgogni
- Renal Transplant Center, Siena University Hospital, Siena, Italy
| | | | - Mario Carmellini
- Renal Transplant Center, Siena University Hospital, Siena, Italy
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Sanders JM, Opdam HI, Furniss H, Hughes PD, Kanellis J, Jones D. Frequency and outcomes of kidney donation from intensive care patients with acute renal failure requiring renal replacement therapy. Nephrology (Carlton) 2019; 24:1296-1303. [PMID: 31081209 DOI: 10.1111/nep.13601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
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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Affiliation(s)
- Jo M Sanders
- DonateLife Victoria, Carlton, Victoria, Australia
| | - Helen I Opdam
- Austin Health, Heidelberg, Victoria, Australia.,Organ and Tissue Authority Canberra, Canberra, Canberra ACT, Australia
| | | | - Peter D Hughes
- Department of Nephrology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine (RMH), Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, Monash Health and Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | - Daryl Jones
- Austin Health, Heidelberg, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Risk factors of acute kidney injury after orthotopic liver transplantation in China. Sci Rep 2017; 7:41555. [PMID: 28134286 PMCID: PMC5278509 DOI: 10.1038/srep41555] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/21/2016] [Indexed: 12/17/2022] Open
Abstract
In this study, we determined the risk factors for acute kidney injury (AKI) following orthotopic liver transplantation (OLT) in China. We collected 5074 donation after cardiac death (DCD) OLT recipients who underwent surgery between January 1, 2010, and December 31, 2015, in 86 academic hospitals or transplant centers in China. Univariate and multivariate analyses were used to investigate the criticality of donor, graft, or recipient variables in the development of post-OLT AKI. In all, 4482 patients were included (median age, 49.31 years). Post-OLT AKI occurred in 3.97% patients, and 73.6% of all OLT patients were male. The 1- and 5-year cumulative survival rates (CSRs) of the AKI group were 33.95% and 25.24%, respectively, compared with 86.34% and 70.05%, respectively, of the non-AKI group (P < 0.001). The independent risk factors for post-OLT AKI were blood loss, cold ischemia time, warm ischemia time, preoperative serum creatinine, the treatment period with dopamine, overexposure to calcineurin inhibitor, and combined mycophenolate mofetil use (P < 0.05). These had a high prediction accuracy for post-OLT AKI (area under the curve [AUC] = 0.740).
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Zongyi Y, Baifeng L, Funian Z, Hao L, Xin W. WITHDRAWN: Risk factors of acute kidney injury after orthotopic liver transplantation in China. EBioMedicine 2016:S2352-3964(16)30357-7. [PMID: 27543153 DOI: 10.1016/j.ebiom.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/28/2016] [Accepted: 08/04/2016] [Indexed: 12/07/2022] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Yin Zongyi
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
| | - Li Baifeng
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China.
| | - Zou Funian
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
| | - Li Hao
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
| | - Wang Xin
- Department of hepatobiliary surgery and organ transplantation, the First Hospital of China Medical University, Shenyang 110001, China
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Ali T, Dimassi W, Elgamal H, Alabassi A, Aleid H, Altalhi M, Shoukri M, Almeshari K. Outcomes of kidneys utilized from deceased donors with severe acute kidney injury. QJM 2015; 108:803-11. [PMID: 25660604 DOI: 10.1093/qjmed/hcv033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Significant numbers of kidneys are discarded due to raised terminal creatinine of the donor. AIM To determine long-term outcomes of kidneys utilized from donors with severe acute kidney injury (AKI). METHODS In this retrospective study, we included all patients who received kidneys from deceased donors between years 2000 and 2012. AKI was defined according to the acute kidney injury network (AKIN) classification. The primary outcomes were patient and graft survival and secondary outcomes were renal function at different time points, delayed graft function, acute rejection and length of hospital stay. RESULTS Two hundred and eighty-four recipients received kidneys from 261 deceased donors. One hundred and fourteen patients (40%) received kidneys from the donors with AKI. Forty-two patients received kidneys from the donors with severe AKI (AKIN-3 category). Mean age of the donor and recipient was 36 and 37 years, respectively. Main cause of death in donors was road traffic accident (34%) followed by cerebrovascular accident (33%). Terminal creatinine was 85 and 262 μmol/l in non-AKI and AKI groups, respectively (P < 0.001). Significantly more patients in the AKI group had delayed graft function (P = 0.006), prolonged hospital stay (P < 0.001) and high creatinine at discharge (P = 0.002). However, acute rejection rates (P = 0.25), 1-, 5- and 10-year graft survival (P = 0.57) and patient survival (P = 0.77) were not different between AKI and non-AKI groups. The outcomes in the AKIN-3 category were comparable with the non-AKI group. CONCLUSIONS This study has shown favorable long-term outcomes of kidneys utilized from donors with severe AKI. This study may encourage healthcare professionals to consider accepting such kidneys.
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Affiliation(s)
- T Ali
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - W Dimassi
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - H Elgamal
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - A Alabassi
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - H Aleid
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - M Altalhi
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - M Shoukri
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
| | - K Almeshari
- From the Department of Kidney and Pancreas Transplant, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia and
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Kidney transplantation from cardiac death donors with terminal acute renal failure. Transplant Proc 2015; 46:1057-60. [PMID: 24815127 DOI: 10.1016/j.transproceed.2013.11.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/18/2013] [Accepted: 11/22/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Kidney transplantation from donation after cardiac death (DCD) donors with terminal acute renal failure (ARF) is not widely accepted due to concern about the organ quality. Here we report our initial clinical outcomes of kidney transplantation from DCD donors with ARF. MATERIALS AND METHODS The results of 29 kidney transplants from ARF DCD donors were compared with those of 60 kidney transplants from non-ARF DCD donors performed at our center from August 2011 to March 2013. RESULTS There was no difference in the incidence of delayed graft function and acute rejection between ARF and non-ARF kidneys (27.6% vs 16.7%, 10.3% vs 8.3%, respectively). Estimated glomerular filtration rate at 12 months was similar between ARF and non-ARF kidneys. With a mean follow-up of 18 months (range 7 to 26 months), actual patient and graft survival rates for ARF DCD recipients were 100% and 96.6%, respectively, which were similar to those of the control group of kidney transplants from non-ARF kidneys (98.3% and 95.0%). CONCLUSIONS Kidneys from DCD donors with terminal ARF have excellent short-term outcomes and may represent another potential method to safely expand the donor pool.
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Li Y, Li J, Fu Q, Chen L, Fei J, Deng S, Qiu J, Chen G, Huang G, Wang C. Kidney transplantation from living related donors aged more than 60 years: a single center experience. Ren Fail 2013; 35:1251-4. [DOI: 10.3109/0886022x.2013.823873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kahan BD. Forty years of publication of Transplantation Proceedings--the fourth decade: Globalization of the enterprise. Transplant Proc 2011; 43:3-29. [PMID: 21335147 DOI: 10.1016/j.transproceed.2010.12.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Barry D Kahan
- Division of Immunology and Organ Transplantation, The University of Texas-Health Science Center at Houston Medical School, Houston, Texas 77030, USA.
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Zuckerman JM, Singh RP, Farney AC, Rogers J, Stratta RJ. Single center experience transplanting kidneys from deceased donors with terminal acute renal failure. Surgery 2009; 146:686-94; discussion 694-5. [DOI: 10.1016/j.surg.2009.06.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 06/05/2009] [Indexed: 11/26/2022]
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Zuckerman JM, Singh RP, Farney AC, Rogers J, Hines MH, Stratta RJ. Successful kidney transplantation from a donation after cardiac death donor with acute renal failure and bowel infarction using extracorporeal support. Transpl Int 2009; 22:798-804. [DOI: 10.1111/j.1432-2277.2009.00860.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
When transplantation started all organs were retrieved from patients immediately after cardio-respiratory arrest, i.e. from non heart-beating donors. After the recognition that death resulted from irreversible damage to the brainstem, organ retrieval rapidly switched to patients certified dead after brainstem testing. These heart-beating-donors have become the principal source of organs for transplantation for the last 30 years. The number of heart-beating-donors are declining and this is likely to continue, therefore cadaveric organs from non-heart-beating donor offers a large potential of resources for organ transplantation. The aim of this study is to examine clinical outcomes of non-heart-beating donors in the past 10 years in the UK as an way of decreasing pressure in the huge waiting list for organs transplantation.
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Affiliation(s)
- Eleazar Chaib
- Nuffield Department of Surgery, John Radcliffe Hospital, University of Oxford, Oxford, England.
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