Dual Kidney Transplantation after Hypothermic Oxygenated Perfusion from Marginal Donor after Circulatory Death with Acute Kidney Injury: A Case Report

Abstract

Donation after circulatory death (DCD) is an increasingly used resource to alleviate chronic renal graft shortages. Organs from donors with progressively increased creatinine levels due to acute kidney injury are used, but the effects of this condition on kidney transplantation are still unclear. Ex-situ machine perfusion is emerging as a potential tool to preserve and resuscitate vulnerable grafts. We report a case of DCD kidneys discarded due to severe acute kidney injury with favorable histological Karpinski score and transplanted after in-situ normothermic regional perfusion (NRP) and ex-vivo hypothermic oxygenated perfusion (HOPE). Kidneys from a 57-years-old man with circulatory death were discarded by other Italian transplant centers due to high serum creatinine level (3.66 mg/dL) at the beginning of NRP and for high values during perfusion. The histological Karpinski score was 2 for both kidneys. We performed in-situ NRP for six hours and subsequently HOPE (240 min for the right kidney and 315 min for the left one). Both kidneys showed good median renal flow and low perfusate’s lactate levels and led us to use them for dual kidney transplantation. The transplant was performed without any complication. The recipient was discharged with serum creatinine 1.44 mg/dL. At two years of follow-up, no complications were registered and serum creatinine level was 0.8 mg/dL.