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Zaphiros NH, Nie J, Noyes K, Luong A, Kayler LK. Donor rhabdomyolysis, acute kidney injury and kidney transplant outcomes. Clin Transplant 2021; 36:e14569. [PMID: 34969156 DOI: 10.1111/ctr.14569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022]
Abstract
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 <25th 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.
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Affiliation(s)
- Nikolas H Zaphiros
- Department of Surgery, University at Buffalo.,Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center
| | - Jing Nie
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo School of Public Health and Health Professions
| | - Albert Luong
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center
| | - Liise K Kayler
- Department of Surgery, University at Buffalo.,Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center
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Choubey AP, Ekwenna O, Rees M, Ortiz J. Kidney Transplants From a Deceased Donor After 11 Days of Venovenous Hemodialysis. EXP CLIN TRANSPLANT 2020; 19:1224-1227. [PMID: 32778018 DOI: 10.6002/ect.2020.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Ankur P Choubey
- From the Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA
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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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Chen CB, Zheng YT, Zhou J, Han M, Wang XP, Yuan XP, Wang CX, He XS. Kidney transplantation from donors with rhabdomyolysis and acute renal failure. Clin Transplant 2017; 31. [PMID: 28564273 DOI: 10.1111/ctr.13021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Chuan-bao Chen
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Yi-tao Zheng
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Jian Zhou
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Ming Han
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Xiao-ping Wang
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Xiao-peng Yuan
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Chang-xi Wang
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Xiao-shun He
- Organ Transplant Center; First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
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Myoglobin casts in renal biopsies: immunohistochemistry and morphologic spectrum. Hum Pathol 2016; 54:25-30. [DOI: 10.1016/j.humpath.2016.02.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/16/2016] [Accepted: 02/24/2016] [Indexed: 11/22/2022]
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Kidney transplantation from a deceased donor with anuric acute kidney injury caused by rhabdomyolysis. Transplantation 2015; 98:e87-8. [PMID: 25402462 DOI: 10.1097/tp.0000000000000475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oliveira da Fonseca E, Jittirat A, Birdwell KA, Fogo AB. Myoglobin cast nephropathy in a kidney transplant patient with normal creatine kinase. Am J Kidney Dis 2014; 65:628-31. [PMID: 25441432 DOI: 10.1053/j.ajkd.2014.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/27/2014] [Indexed: 11/11/2022]
Abstract
Delayed graft function in kidney transplant recipients is a known complication associated with increased risk of acute rejection and reduced transplant survival after 1 year. There are multiple risk factors, including prolonged cold ischemia time, donor age, and cause of donor's death. Major causes of delayed graft function are acute kidney injury in the donor, often from prolonged terminal ischemia, reflected by acute tubular injury in the recipient. However, the differential diagnosis of delayed graft function includes acute rejection, recurrence of the primary glomerular diseases, and other less commonly encountered conditions. A transplant kidney biopsy usually is required to elucidate the correct cause and initiate the right treatment, which is crucial for transplant survival. We report a case of a transplant recipient who developed delayed graft function due to an uncommon cause. After correct diagnosis, the patient's transplant function improved.
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Affiliation(s)
- Elissa Oliveira da Fonseca
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - Arksarapuk Jittirat
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Kelly A Birdwell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Agnes B Fogo
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN.
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Farney AC, Rogers J, Orlando G, al-Geizawi S, Buckley M, Farooq U, al-Shraideh Y, Stratta RJ. Evolving experience using kidneys from deceased donors with terminal acute kidney injury. J Am Coll Surg 2013; 216:645-55; discussion 655-6. [PMID: 23395159 DOI: 10.1016/j.jamcollsurg.2012.12.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/11/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney transplantation from deceased donors with terminal acute kidney injury (AKI) is not widely accepted. STUDY DESIGN Acute kidney injury donor kidneys were defined by a doubling of the donor's admission serum creatinine (SCr) level and a terminal SCr level >2.0 mg/dL before organ recovery. RESULTS Over 5.5 years, we transplanted 84 AKI donor kidneys, including 64 kidneys from standard criteria donors (SCD), 11 from expanded criteria donors (ECD), and 9 from donation after cardiac death (DCD) donors. Mean donor age was 36 years (range 15 to 68 years); mean admission and terminal donor SCr levels were 1.25 mg/dL and 3.2 mg/dL, respectively (mean terminal estimated glomerular filtration rate 25.5 mL/minute). With a mean follow-up of 35 months (range 6 to 70 months), actual patient and graft survival rates are 98% and 89%, respectively, which are numerically, but not statistically, higher than concurrent kidney transplants from brain-dead (non-AKI) SCDs at our center. Delayed graft function (DGF) occurred in 34 patients (40%). Mean 1-, 12-, and 24-month SCr levels were 1.8, 1.6, and 1.7 mg/dL, respectively. Delayed graft function was associated with lower 3-year graft survival for non-AKI SCD transplants (68% vs 90%, with and without DGF), but there was no impact of DGF on graft survival for AKI donor kidneys (89% vs 91%). CONCLUSIONS Although AKI donor kidneys more commonly have DGF, the higher rate of DGF does not worsen graft outcomes. Kidneys from deceased donors with terminal AKI transplanted into appropriately selected patients have excellent medium-term outcomes and represent a method to safely expand the donor pool.
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Affiliation(s)
- Alan C Farney
- Department of General Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Rhabdomyolysis with acute kidney injury in deceased donors is not a contraindication for kidney donation. Int Urol Nephrol 2012; 44:1107-11. [DOI: 10.1007/s11255-012-0185-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 04/19/2012] [Indexed: 01/05/2023]
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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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Mekeel KL, Moss AA, Mulligan DC, Chakkera HA, Hamawi K, Mazur MJ, Heilman RL, Reddy KS. Deceased donor kidney transplantation from donors with acute renal failure due to rhabdomyolysis. Am J Transplant 2009; 9:1666-70. [PMID: 19459799 DOI: 10.1111/j.1600-6143.2009.02663.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the current shortage of solid organs for transplant, the transplant community continues to look for ways to increase the number of organ donors, including extending the criteria for donation. In rhabdomyolysis, the byproducts of skeletal muscle breakdown leak into the circulation resulting in acute renal failure in up to 30% of patients. In nonbrain dead patients, this condition is reversible and most patients recover full renal function. Seven potential donors had rhabdomyolysis with acute renal failure as evidenced by the presence of urine hemoglobin, plasma creatinine kinase levels of greater than five times the normal and elevated creatinine. One donor required dialysis. At our institution, 10 kidneys were transplanted from the seven donors. Two grafts had immediate function, five grafts experienced slow graft function and three grafts had delayed graft function requiring hemodialysis. At a mean of 8.7 months posttransplant (2.4-25.2 months), all patients have good graft function, are off dialysis and have a mean creatinine of 1.3 (0.7-1.8). In conclusion, our experience suggests that rhabdomyolysis with acute renal failure should not be a contraindication for donation, although recipients may experience slow or delayed graft function.
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Affiliation(s)
- K L Mekeel
- Division of Transplantation, Hepatobiliary and Pancreatic Surgery, Department of Surgery, Mayo Clinic, AZ, USA.
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Greenstein SM, Moore N, McDonough P, Schechner R, Tellis V. Excellent outcome using “impaired” standard criteria donors with elevated serum creatinine. Clin Transplant 2008; 22:630-3. [DOI: 10.1111/j.1399-0012.2008.00835.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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