Viability assessment and utilization of declined donor kidneys with rhabdomyolysis using ex vivo normothermic perfusion without preimplantation biopsy. Issue 3 (19th October 2020)

• Record Type: Journal Article
• Authors: Pearson, Robert; Asher, John; Jackson, Andrew; Mark, Patrick B.; Shumeyko, Vlad; Clancy, Marc J.
• Is Part Of: American journal of transplantation. Volume 21:Issue 3(2021)
• Page Start: 1317
• Page End: 1321
• Publication Date: 2020-10-19
• Subjects: clinical decision‐making -- clinical research/practice -- delayed graft function (DGF) -- donors and donation: donation after circulatory death (DCD) -- kidney transplantation/nephrology -- organ acceptance -- organ perfusion and preservation; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.16329
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : The role of ex vivo normothermic perfusion (EVNP) in both organ viability assessment and reconditioning is increasingly being demonstrated. We report the use of this emerging technology to facilitate the transplantation of a pair of donor kidneys with severe acute kidney injury (AKI) secondary to rhabdomyolysis. Donor creatinine was 10.18 mg/dl with protein (30 mg/dl) present in urinalysis. Both kidneys were declined by all other transplantation units and subsequently accepted by our unit. The first kidney was perfused with red cell‐based perfusate at 37°C for 75 min, mean renal blood flow was 110 ml/min/100 g and produced 85 ml of urine. Having demonstrated favorable macroscopic appearance and urine output, the kidney was transplanted into a 61‐year‐old peritoneal dialysis dependent without complication. Given the reassuring information from the first kidney provided by EVNP, the second kidney was not perfused with EVNP and was directly implanted to a 64‐year‐old patient. The first kidney achieved primary function and the second functioned well after delayed graft function. Recipient eGFR have stabilized at 88.5 and 55.3, respectively (ml/min/1.73 m 2 ), at 2 months posttransplant. Abstract : Favorable viability assessment during normothermic perfusion of one kidney from a donor who suffered severe acute kidney injury secondary to rhabdomyolysis can facilitate transplantation of both kidneys into two recipients.