[Kidney transplants from donors burdened metabolic acidosis in the course of poisoning with methanol and carbon monoxide].
The question of obtaining organs from donors who died of methanol poisoning has been discussed in the medical literature for many years. The results of such transplants published so far are very optimistic. However, the possibility of permanent and significant injury to transplanted organs caused by poisons or its metabolites raises serious concerns regarding the procedure. The long-term effects of intensive treatment of poisoning need to be considered as well. Metabolic acidosis and high blood osmolality are agents with recognized damaging potential impairing organ function at cellular level. The study traced the fate of kidney transplants from 13 donors who died of methanol poisoning and one isoned with carbon monoxide. The donors group consisted of 12 men and 2 women, of mean age 49 years (SD +/- 7.93). The kidneys were transplanted 20 men and 8 women. The mean age of recipients was 50.29 years (SD +/- 12.9). At the time of admission to the Department of Toxicology all donors presented with profound metabolic acidosis and high plasma osmolality (mean 434.71 mOsm/kg H2O (SD +/- 73.29). Metabolic acidosis was treated high doses of sodium bicarbonate (mean infusion volume of was 409 ml) before the HD procedure. Blood methanol levels were between 125 and 470 mg% (mean 317.23 SD +/- 136.83). The carboxyhaemoglobin concentration of in the donor poisoned with carbon monoxide was 47.2%. Transplantation was performed after confirmation of the brain death, the period of cold ischemia (CIT) ranged from 6 to 22 hours (mean 16.06 hours; SD +/- 3.99). Kidneys have taken function immediately after transplantation in 21 recipients. In seven cases, patients required two or three HD procedures. A total of 16 dialysis were performed post-transplants. In the group of patients, the mean glomerular filtration rate (GFR) at 3 months after transplantation was 46.71 ml/min/1.73m2 (SD +/- 10.89). During the 18 months follow-up a constant upward trend to the mean GFR 50.55 was noticed. In the group of donors, the mean blood urea concentration (BUN) 3 months after transplantation was 61.43 mg/dL, including 7 patients with BUN within the range of 80-100 mg/dL. At 18 months post transplant, the average concentration was 42.36 mg/dL, with no cases exceeding 55 mg/dL. Similarly, serum creatinine level normalized with the mean value of 3.01 mg/dL at 3 months and 1.68 mg/dL at 18 months post the procedure. There was no case exceeding 2 mg/dL. One recipient died of a heart attack after a period of more than 18 months after transplantation. However, the transplant was efficiently active at all times (GFR 56-60 ml).
Oddzial Toksykologii, Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy w Łodzi. zbiko@imp.lodz.pl
Zbigniew
Z
Kołaciński
Oddzial Urologii i Transplantacji Nerek Szpital im. M. Pirogowa w Lodzi.
Agnieszka
A
Skrzypek-Mikulska
Oddzial Urologii i Transplantacji Nerek Szpital im. M. Pirogowa w Lodzi.
Ewelina
E
Pitrus
Oddzial Urologii i Transplantacji Nerek Szpital im. M. Pirogowa w Lodzi.
Józef
J
Matych
Oddzial Toksykologii, Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy w Łodzi.
Renata
R
Winnicka
Oddzial Toksykologii, Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy w Łodzi.
Sylwia
S
Czyzewska
Oddzial Toksykologii, Klinika Chorób Zawodowych i Toksykologii, Instytut Medycyny Pracy w Łodzi.
Anna
A
Krakowiak
D000138:Acidosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D005260:Female; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D000432:Methanol / Q000097:blood / Q000506:poisoning*; D008875:Middle Aged; D017693:Sodium Bicarbonate / Q000627:therapeutic use; D014019:Tissue Donors
D017693:Sodium Bicarbonate; D000432:Methanol