Using kidney grafts from deceased donors with acute kidney injury due to rhabdomyolysis. Is it possible?

Abstract

Introduction: Kidney transplantation (KT) is the therapy of choice for end-stage renal disease. The universal imbalance between demand for KT and available donors requires the development of new strategies to increase the supply of renal grafts. Among these, there is an increasing living-donor KT and the use of expanded criteria donors (ECD). Grafts with acute kidney injury (AKI) are one of the ECD situations, and its use remains controversial due to the uncertainty of kidney recovery after KT. Rhabdomyolysis (RB) is the cause for 7 to 10% of grafts with AKI, resulting from the release of myoglobin in the circulation and consequent tubular lesion by various mechanisms. Purpose: Motivated by a recent offer of renal graft with RB and subsequent non-authorization for use by the Organ Procurement Organization, the authors aimed to review the literature about the KT feasibility from deceased donor with RB. Methods: Medline database literature review using specific keywords between 2000 and 2018. Results: Seven articles demonstratedseries with 51 KT from RB grafts. Of these 29 donors with RB, 20.7% were on hemodialysis, and the 1.13mg/dL mean creatinine. RB grafts presented delayed graft function in 35.3% of cases, but one month after surgery, kidneys showed complete recovery and normal function, confirmed by biopsy. Discussion: There is great disproportion between the number of patients on the waiting list for kidney and available donors. For this reason, there is need to improve and ease the acceptance criteria of renal grafts either by donors with circulatory death and donors with AKI. RB is one of the causes of AKI among deceased donors. KT from donors with RB showed a higher rate of delayed graft function, but fully recovered around 30 days after transplantation. Conclusion: In Brazil, there are no well-set criteria for using renal grafts with RB, but current studies demonstrate good outcomes and recovery of renal function in the majority of these cases. So far, the use of renal grafts with RB should be at discretion and judgment of each team.