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2018 ; 97
(26
): e11106
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Kidney Transplantation from an extracorporeal membrane oxygenation-supported
brain-dead donor: A case report
#MMPMID29952950
Chiang PJ
; Tang SH
; Li CC
; Chou MH
; Lin YC
; Wu ST
Medicine (Baltimore)
2018[Jun]; 97
(26
): e11106
PMID29952950
show ga
RATIONALE: Extracorporeal membrane oxygenation (ECMO) can deliver effective
respiratory and circulatory maintenance to organ donors, improve organ function,
and shorten warm ischemic time before harvesting. However, ECMO-supported
brain-dead donors (DBDs) still have a high risk of acute kidney injury related to
decreased renal oxygen delivery and inflammatory damage, which may cause early
graft failure. PATIENT CONCERNS: Kidney transplantation from an ECMO-supported
DBD. DIAGNOSES: We found an extremely abnormal "very dark blue" appearance of the
graft kidneys from an ECMO-supported DBD during kidney procurement.
INTERVENTIONS: Rather than discarding the graft kidneys, we performed an on-table
biopsy. Pretransplant biopsy results revealed minimal interstitial fibrosis in
the section of these graft kidneys. OUTCOMES: Two candidates received graft
kidneys, and the two grafts remained functional until the 8-month follow-up.
LESSONS: Currently, there is no standard method for evaluating graft kidney
function of ECMO-supported DBDs. Regardless of the donors' preoperative serum
creatinine (SCr) level, estimated glomerular filtration rate (eGFR), or gross
appearance of the graft kidney, we believe that it is more reliable to include
pretransplant biopsy as a criterion in clinical practice to safely accept kidneys
from ECMO-supported DBDs.
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