Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy

Yeon Lee Ju; Hoon Kim Young; Wook Kwon Hyun; Yoon Choi Ji; Sung Shin; Hee Jung Joo; Ja Hong Jung; Jong Han Duck

doi:10.4285/jkstn.2015.29.4.233

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Ju, Young, Hyun, Ji, Shin, Joo, Jung, and Duck: Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy

Original Article

J Korean Soc Transplant 2015;29(4):233-237.

Published online: 10 December 2015

DOI: https://doi.org/10.4285/jkstn.2015.29.4.233

Kidney Transplantation from the Deceased Donor Who Need Continuous Renal Replace Therapy

Yeon Lee Ju, M.D.¹, Hoon Kim Young, M.D.¹, Wook Kwon Hyun, M.D.¹, Yoon Choi Ji, M.D.¹, Sung Shin, M.D.¹, Hee Jung Joo, M.S.¹, Ja Hong Jung, M.S.², Jong Han Duck, M.D.¹

¹Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Organ Transplant Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding author: Young Hoon Kim, Division of Kidney and Pancreatic Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-3938, Fax: 82-2-474-9027 E-mail: kyh-001@hanmail.net

Received 31 July 2015 Revised 30 November 2015 Accepted 7 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Brain death donors may require continuous renal replacement therapy (CRRT) in severe acute renal failure (ARF) during management. To maximize donor organ usage we performed renal transplantation from deceased donors requiring CTTR with informed consent. This singlecenter study reviewed the clinical outcomes of kidney transplant recipients from extreme marginal donors requiring CRRT.

Methods

Medical records of all patients using a graft from extreme marginal donors who underwent CRRT in Asan Medical Center between June 2007 and September 2014 were reviewed retrospectively.

Results

Between June 2007 and September 2014, 27 kidneys were transplanted from 19 CRRT donors. Mean donor age was 35.1 years (range; 16∼56), male donors were 14 (74%). The causes of brain death included head trauma in 6, hypoxia in 5, stroke in 4, and others in 4. The main causes of CRRT were anuria in 14, electrolyte imbalance or acidosis in 5, and mean duration of donor CRRT was 3.6 days (range; 1∼11). Delayed graft function (DGF) developed in 24 (88.9%), but all recovered renal function; they can be free from dialysis 11 days after transplantation. Mean serum creatinine level at 1 month, 1 year, and 5 years was 1.85, 1.26, and 1.31 mg/dL, respectively.

Conclusions

Five-year follow-up data showed that renal transplantation from severe ARF donor has an excellent outcome. Although CRRT donor kidney transplants have a higher rate of DGF, the presence of DGF, unlike other donation after brain death donor kidney transplants, does not portend a worse prognosis.

Keywords: Kidney transplantation, Expanded criteria donor, Acute kidney injury, Continuous renal replacement therapy

References

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Fig. 1.

Serum creatinine in all recipients (n=27). Serum creatinine of all recipients during follow up mean 3.8 years (range; 0.9∼8.1). one patient died from donor derived scedosporium infection (post transplant 58th day).

Fig. 2.

The mean serum creatinine of two group (continuous renal replacement therapy [CRRT] donor vs. standard criteria donor [SCD]). Each groups showed no significant difference finally. In the first month after transplantation, the CRRT group showed higher serum creatinine level due to high rate of delayed graft function.

Table 1.

Recipients characteristics (n=27)

Demographic	Value
Age (yr)	41±12
Male sex	19 (70)
Duration of RRT (mo)	78±25
Waiting duration	55±19
PRA class I ＞50%	1 (3.7)
PRA class II ＞50%	2 (7.4)
Cause of ESRD
Diabetes mellitus	3 (11.1)
Hypertension	7 (25.9)
Glomerulonephritis	10 (37.0)
PCKD	1 (3.7)
Unknown	6 (22.2)

Data are presented as mean±SD or number (%).

Abbreviations: RRT, renal replacement therapy; PRA, panel reactive antibody; ESRD, end stage of renal disease; PCKD, polycystic kidney disease.

Table 2.

Donor characteristics (n=19)

Demographic	Value
Age (yr)	35±10
Male sex	14 (74)
Final creatinine (mg/dL)	4±2.08
Peak creatinine (mg/dL)	5.06±3.25
Final hourly urine (mL)	35±78 (0∼360)
Duration of CRRT (day)	3.6±3.1 (1∼11)
Diabetes	1 (5.3)
Hypertension	1 (5.3)
Cause of death
CVA	5 (26.3)
Trauma	6 (31.6)
Hypoxic	5 (26.3)
Others	3 (15.8)

Data are presented as mean±SD, number (%), or mean±SD (range).

Abbreviations: CRRT, continuous renal replacement therapy; CVA, cardiovascular accident.

Table 3.

Baseline characteristics of CRRT donor group and SCD group

Variable	CRRT (n=19)	SCD (n=257)	P-value
Age (yr)	34±11.82	38±15.12	0.27
Sex (male:female)	14:05	176:81	NS
Cause of death			NS
CVA	5	101
Hypoxic	8	40
Trauma	6	73
Others	0	42
Pre-donation sCr (mg/dL)	3.24±1.56	1.48±1.186	0.00
Underlying disease
DM or HTN	3	41	NS

Data are presented as mean±SD or number.

Abbreviations: CRRT, continuous renal replacement therapy; SCD, standard criteria donor; NS, not significant; CVA, cardiovascular accident; sCR, serum creatinine; DM, diabetes mellitus; HTN, hypertension.

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