ARF Need Not Prevent Kidney Donation

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The use of kidneys from deceased donors with acute renal failure (ARF) can be safe and produce good renal function up to one year after transplantation, new research has confirmed.

A Montreal team reviewed the outcomes from 196 cadaveric kidneys they had transplanted from January 2006 to December 2010. Among these, 29 were from donors with ARF according to the Acute Kidney Injury Network (AKIN) definition. Two of the recipients had venous thrombosis of the transplanted kidneys shortly after surgery and the investigators excluded them from the analysis. Not all data were available for all of the patients.

Fourteen women and 15 men received the kidneys. Their mean age was 53 years, 25 had a panel reactive antibody percentage at transplant of 1%-19%, and the mean cold ischemia time was 942 minutes.

Five patients experienced delayed graft function (DGF) post-transplant. Another 11 had slow recovery of function and three had biopsy-proven acute rejection. Overall, six required dialysis immediately post-transplant. The mean creatinine values were 140.8 µmol/l at one month post-transplant, 126.5 µmol/L at three months, 122.5 µmol/L at six months, 123.3 µmol/L at one year, and 127.3 µmol/L at five years.

“If you have data showing the kidney function was normal prior to the event that led to the ARF and death, then you can be reasonably confident of a good outcome,” said lead investigator Lynne Senécal, MD, a nephrologist and Adjunct Clinical Professor at the Hôpital Maisonneuve-Rosemont in Montreal. “Since there are so few organs to choose from, before refusing kidneys from someone with ARF you should think twice, because sometimes, if the donors were young and not sick prior to the fatal event, they can function well.”

Dr. Senécal presented the results at the Canadian Society of Transplantation's 2012 Annual Meeting.

The findings mirror those of an earlier French study (Nephrol Dial Transplant 2010;25:1980-1986). It showed an average of 7.6 days' renal-recovery time among 52 patients who received kidneys from deceased donors with ARF. This study, however, also indicated that renal function was lower post-transplant among patients who received kidneys from donors who were older, whose cause of death was related to cardiovascular factors, cerebral hemorrhage, or stroke, or who had previous cardiovascular disease.

The Quebec team did not examine these relationships, but Dr. Senecal and some of her colleagues are studying ARF and non-ARF kidneys to analyze these variables.

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