A Successful Transplantation from Maastricht Category-4 Non-Heart Beating Donor

Abstract

The shortage of available organs is the limiting factor for kidney transplantation (Ktx). One of the strategies to increase access to Ktx is the use of non-heart beating (NHB) donors. We herein present a successful Ktx from an NHB (Maastricht Category-4) donor. The donor was a 21-year-old woman who had brain death due to cerebrovascular accident. She had severe hypotension for three hours despite 30 μg/kg/min dopamine infusion, followed by cardio-pulmonary arrest just before the operation began. Cardio-pulmonary resuscitation was consequently initiated and continued during the operation. Donor organ harvesting (hepatectomy and bilateral nephrectomy) was performed after direct aortic cannulation. The warm ischemia time was 35 minutes. The recipient was a 54-year-old man who had undergone hemodialysis for four years. There were 3/6 mismatches, and the lymphocyte cross-match was negative. The induction immunosuppressive was anti-thymocyte globulin, followed by tacrolimus/ MMF/steroid after the 12th day. He had delayed graft function and hemodialysis was required at the third and sixth days. The urine output gradually increased and sCr slowly declined afterwards and he discharged with sCr 1.5 mg/dl on the 24th day. At the first year of transplantation, he is in good clinical condition with a stable baseline sCr of 1.5 mg/dl. NHB donors can be an alternative and important source to expand the kidney donation pool, and successful long-term outcomes favor this modality.