Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death

Yusuke Tomita, MD; Kazuhiro Iwadoh, MD; Yuichi Ogawa, MD; Katsuyuki Miki, MD; Kotaro Kai, MD; Akihito Sannomiya, MD; Toru Murakami, MD; Ichiro Koyama, MD; Kumiko Kitajima, MD; Ichiro Nakajima, MD; Shohei Fuchinoue, MD

doi:10.1097/TXD.0000000000000768

Transplantation Direct (Apr 2018)

Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death

Yusuke Tomita, MD,
Kazuhiro Iwadoh, MD,
Yuichi Ogawa, MD,
Katsuyuki Miki, MD,
Kotaro Kai, MD,
Akihito Sannomiya, MD,
Toru Murakami, MD,
Ichiro Koyama, MD,
Kumiko Kitajima, MD,
Ichiro Nakajima, MD,
Shohei Fuchinoue, MD

Affiliations

Yusuke Tomita, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Kazuhiro Iwadoh, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Yuichi Ogawa, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Katsuyuki Miki, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Kotaro Kai, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Akihito Sannomiya, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Toru Murakami, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Ichiro Koyama, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Kumiko Kitajima, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Ichiro Nakajima, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.
Shohei Fuchinoue, MD: 1 Tokyo Women’s Medical University, Department of Surgery III, Tokyo, Japan.

DOI: https://doi.org/10.1097/TXD.0000000000000768
Journal volume & issue: Vol. 4, no. 4
p. e355

Abstract

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Abstract. Chronic shortages of organs for transplantation have led to the use of marginal kidneys from donors after circulatory death with acute kidney injury (AKI), but the utilization of kidneys with severe AKI is not well established. We retrospectively analyzed eight kidney transplantation (KTx) cases from donation after circulatory death (DCD) with terminal creatinine (t-Cr) concentrations higher than 10.0 mg/dL and/or oliguria for more than 5 days (AKI network criteria: stage III). Although all patients showed delayed graft function, no cases of primary nonfunction (PNF) were found. Five patients maintained stable renal function for approximately 15.5, 10, 10, 5, and 0.5 years after KTx. Only 1 patient showed biopsy-proven acute rejection. Also, 2 patients developed graft failure: one attributable to chronic antibody mediated rejection at 11.3 years after KTx, and one attributable to recurrence of IgA nephropathy at 4.6 years after KTx. Kidneys with AKI stage III yielded great outcomes without the risk of primary nonfunction and rejection. Although the AKI kidneys were associated with delayed graft function, these results suggest that even the most severe kidneys with AKI stage III from DCD donors can be considered a valid alternative for recipients on a waiting list for KTx.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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