Kidney transplantation from a deceased donor with anuric acute kidney injury caused by rhabdomyolysis

Donor rhabdomyolysis, acute kidney injury and kidney transplant outcomes

BACKGROUND

Donor rhabdomyolysis may constrain kidney utilization due to anticipated unfavorable graft outcomes-especially in combination with acute kidney injury (AKI). There is a paucity of empiric data to inform organ acceptance decision-making.

METHODS

A single-center retrospective cohort study of adult transplant recipients of deceased-donor kidneys with reported donor creatine phosphokinase (CPK) levels was conducted between 2014 and 2020. Recipients of CPK ≥ 1000 U/L kidneys were propensity matched to CPK < 1000 recipients according to outcome-predictive baseline covariates, except AKI.

RESULTS

A total of 254 kidney transplants were propensity matched into CPK ≥ 1000 (n = 90) vs CPK<1000 (n = 90) groups. Transplant outcomes with high versus low CPK kidneys were similar in terms of delayed graft function (p = 0.64), 1-year estimated glomerular filtration rate <25^th percentile (p = 0.69) and mean (p = 0.58), and time to all-cause graft failure (p = 0.58). There was no interaction between AKI and high CPK for these outcomes. Extreme CPK thresholds as high as >8672 U/L were not associated with overall graft survival in the unmatched sample (p = 0.81).

CONCLUSIONS

In a single center study, donor rhabdomyolysis was not associated with short-term kidney transplant graft outcomes, nor was there an additive effect of AKI. However, studies with greater CPK and AKI severity and longer follow-up are warranted. This article is protected by copyright. All rights reserved.

Kidney Transplants From a Deceased Donor After 11 Days of Venovenous Hemodialysis

There have been several studies exploring the viability of kidneys procured from extended criteria donors with acute kidney injury. Previous publications have evaluated the long-term outcomes of kidneys after acute kidney injury. We describe the case of 2 transplants from a donor with acute renal failure after a motor vehicle accident. The donor required 11 days of venovenous hemodialysis before procurement. There have not been any previous reports of donations following such a prolonged period of dialysis. The kidneys were shared across organ procurement organization service areas and had cold ischemia times of 32 hours and 26 hours. Both recipients had delayed graft function. One recipient had several complications that required multiple readmission for treatment. At last follow-up, both transplanted organs were functioning adequately and producing urine. This case report presents a novel opportunity to understand the extent of possible kidney transplant after acute kidney injury.

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

BACKGROUND

Whether organs from donors after brain death (DBD) with acute kidney injury (AKI) should be accepted for transplantation is still a matter of debate.

METHODS

This was a retrospective, center-based, matched cohort study of 33 renal transplant patients who received a renal allograft from a DBD with AKI. Sixty-five kidney transplants without donor AKI transplanted directly before and after the index transplantation served as controls.

RESULTS

All AKI donors were classified according to RIFLE criteria: 9.1 % Risk, 54.6 % Injury, and 36.4 % Failure. Mean serum creatinine was 2.41 ± 0.88 mg/dL at procurement and 1.06 ± 0.32 mg/dL on admission. AKI donors had lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009) and received more frequently noradrenaline (93.9 vs. 72.3 %, p = 0.02) and/or adrenaline (15.2 vs. 1.5 %, p = 0.02). Recipient and transplant characteristics were similar except a more favorable HLA match in control patients (p = 0.01). Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 [27.7 %], p = 0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14. One-year graft survival was very similar when comparing the groups (93.6 % [95 % CI 76.8-98.4 %] vs. 90.3 % [95 % CI 79.6-95.5 %], log rank p = 0.58).

CONCLUSIONS

Kidneys from AKI donors can be transplanted with excellent intermediate prognosis and should not be discarded.