Korean J Transplant.  2022 Nov;36(Supple 1):S151. 10.4285/ATW2022.F-2710.

Kidney transplantation from deceased donor treated with continuous renal replacement therapy due to acute kidney injury and anuria: a case report

• Ban TH
• Youn S
• Cho HJ
• Lee YS
• Park M
• Kim MH
• Park HS
• Lim J
• Hwang JK
• Choi BS

• KMID: 2535667
• DOI: http://doi.org/10.4285/ATW2022.F-2710

Abstract

Background
Heart-beating organ donors are in a variety of conditions. The number of brain-dead donors with serum creatinine 3 mg/dL or higher with anuria is small. It is difficult to predict the outcome of kidney transplantation from such a donor. Herein, we report a case of a successful kidney transplantation from a deceased donor who underwent continuous renal replacement therapy (CRRT) for 5 days with acute kidney injury (AKI) and anuria.
Methods
A 34-year-old male developed sudden cardiac arrest, presumably due to respiratory by asthma aggravation. He was return of spontaneous circulation with cardiopulmonary resuscitation during total 44 minutes. At the time of admission, serum creatinine 1.08 mg/dL, but on hospital day 3, serum creatinine 5.62 mg/dL, 24-hour urine output of 300 mL. He received CRRT owing to norepinephrine use. Thereafter he showed anuria for 5 days. The patient did not recover from the hypoxic brain injury on the hospital day 8 and remained brain death.
Results
The recipient was a 37-year-old female. She was undergoing hemodialysis (HD) for 4 years and 7 months. Her primary renal disease was hypertension. Immunologic studies included negative results of crossmatch test and panel reactive antibody. The induction and maintenance immunosuppressive agents were basiliximab, with tacrolimus, mycophenolate, and glucocorticoid. After transplantation, she underwent hemodialysis due to delayed graft function from postoperative day (POD) 4. However, she underwent an allograft biopsy at POD 12. Allograft findings revealed severe acute tubular necrosis and subcapsular cortical necrosis. Finally, her serum creatinine decreased from POD 16. The patient discharged with serum creatinine 2.2 mg/dL at POD 22. Her renal function was 0.91 mg/dL of serum creatinine 18 months after transplantation.
Conclusions
Allograft kidney of deceased donor candidates with severe acute kidney injury can ensure successful transplant outcomes with appropriate management for peritransplant period.