Expanding the criteria of renal kidneys for transplantation: use of donors with acute renal failure.
BACKGROUND
Increased numbers of patients waiting for renal transplantation have led to widening selection criteria for grafts. Thus, we have evaluated the outcome of transplanted kidneys procured in the presence of acute renal failure (ARF).


METHODS
Transplant patients (n = 52) with a kidney procured with ARF were studied. Clinical data from donors and recipients, serum creatinine (SCr), creatinine clearance [estimated glomerular filtration rate (eGFR)], cold ischaemia duration, time to urine flow recovery or renal function recovery, and the number of haemodialysis sessions, were collected retrospectively.


RESULTS
Mean donor age was 45.7 +/- 12.7 years, and the mean SCr at the time of harvesting was 276.3 +/- 104.2 micromol/l. Recipients' mean age was 51.1 +/- 12.1 years. After transplantation, recovery of renal function was observed after 7.6 +/- 7.1 days, and required 1.9 +/- 3.0 haemodialysis sessions. SCr was 124.6 +/- 49.5 micromol/l, and eGFR was 56.2 +/- 19.8 ml/min at last follow-up. eGFR was significantly lower if the donor's death was due to stroke or cerebral haemorrhage (CH), or if the donors had previous cardiovascular disease (CVD) (P < 0.02). Patients with eGFR of <50 ml/min (n = 23) had donors who were older, and whose cause of death was more frequently related to CVD factors or to CH/stroke (P < 0.03). There were no significant differences between the two groups regarding age of recipient, gender of the donor or recipient, cold ischaemia time, occurrence of cardiac arrest, collapse or acute rejection. Linear regression analysis indicated that donor age and occurrence of acute rejection were independent factors associated with eGFR.


CONCLUSIONS
ARF before organ procurement does not have a negative effect on subsequent renal function. However, old age, CVD risk factors or CH, and late renal function recovery after transplantation are correlated with subsequent lower renal function. Thus, renal grafts with ARF can be used for renal transplantations.
Deroure
Benjamin
B
Department of Nephrology, Dialysis and Transplantation, Le Kremlin Bicetre, University Paris XI, APHP, France.
Kamar
Nassim
N
Depreneuf
Helene
H
Jacquet
Antoine
A
Francois
Helene
H
Charpentier
Bernard
B
Rostaing
Lionel
L
Durrbach
Antoine
A
D058186:Acute Kidney Injury / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D005602:France; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D055815:Young Adult