Renal transplants from non-heart beating paracetamol overdose donors.
BACKGROUND
Non-heart beating donors (NHBD) are widely encouraged to avert the critical shortage in the kidney donor pool. Ischaemic injury at the time of cardiac arrest in the NHBD is more pronounced and therefore the kidneys resulting are considered marginal. This review describes our experience with four kidneys from two controlled NHBDs who were exposed to paracetamol intoxication and subsequently were treated with mannitol prior to organ donation.


METHODS
Two patients with fulminant liver failure following paracetamol overdose were referred as 'withdrawal of treatment' NHBD. As the two patients had developed hepatic encephalopathy they were treated with mannitol to reduce intra-cerebral oedema. The two donors were oligoanuric for at least 24 h prior to cardiac arrest. Following cardiac arrest, in situ perfusion was carried out and the kidneys were removed. One pair of kidneys were machine perfused while the second pair of kidneys were cold stored prior to transplantation.


RESULTS
Pre-transplant assessment of NHBD kidneys resulted in three of four kidneys being transplanted. The NHBD kidneys exhibited a period of delayed graft function (DGF). The early transplant biopsies showed evidence of diffuse cytoplasmic vacuolation. These histological features disappeared with time and the renal function improved until the time of discharge.


CONCLUSIONS
Non-heart beating donor kidneys are considered marginal and the effect of mannitol and paracetamol drug intoxication will induce reversible sub-lethal injury. A period of dialysis is inevitable in clearing the reactive intermediates of mannitol and paracetamol. The kidneys behaved as traditional controlled NHBD at time of discharge.
Gok
Muhammed A
MA
Renal Transplant Unit, The Freeman Hospital, University of Newcastle Upon Tyne, England, UK. m.a.gok@ncl.ac.uk
Gupta
Ajay
A
Olschewski
Peter
P
Bhatti
Aftab
A
Shenton
Brian K
BK
Robertson
Helen
H
Soomro
Naeem
N
Talbot
David
D
D000082:Acetaminophen / Q000506:poisoning*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D001929:Brain Edema / Q000517:prevention & control; D015925:Cryopreservation; D004234:Diuretics, Osmotic / Q000627:therapeutic use; D062787:Drug Overdose; D005260:Female; D006085:Graft Survival; D006323:Heart Arrest / Q000139:chemically induced*; D006501:Hepatic Encephalopathy / Q000139:chemically induced; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D009926:Organ Preservation; D014019:Tissue Donors
D018712:Analgesics, Non-Narcotic; D004234:Diuretics, Osmotic; D000082:Acetaminophen; D008353:Mannitol