Kidney transplantation from cardiac death donor of hypertensive cerebral hemorrhage: a report of 27 cases

Abstract

Objective To explore the effect of kidney transplantation from cardiac death standard criteria donors of hypertensive cerebral hemorrhage (HCH).Method The clinical data of donation after cardiac death (DCD) donors died from HCH (n =14) or brain trauma (n =19) and their renal transplant recipients were retrospectively analyzed.All donors fell into China Category Ⅱ or Ⅲ and were standard criteria donors.Twenty-seven recipients received kidney transplants from HCH donors (HCH group) and 38 recipients received kidney transplants from brain trauma donors (brain trauma group).All kidneys from HCH donors and 8 kidneys from brain trauma donors were preserved by machine perfusion.The immunosuppressive therapy protocol of two groups were similiar.The results of kidney transplantation from HCH donors were analyzed and compared to those from DCD donors died from brain trauma.Result The mean maximal calculated creatinine clearance rate of the HCH donors was significantly lower than that of the brain trauma donors (86.6 ± 19.5 vs.129.6 ±46.5 ml/min,P =0.001).All kidneys from HCH donors showed glomerulosclerosis to varying degrees (13.5％ ± 6.9％).After transplantation,the incidence of delayed graft function (18.5％ in HCH group vs.10.5％ in brain trauma group) and acute rejection (14.8％ in HCH group vs.7.9％ in brain trauma group) of two groups were similar (P＞0.05).The HCH group had significantly lower estimated glomerular filtration rate (eGFR) at 1st,6th and 12th month after transplantation (50.0± 11.7,50.1 ± 13.8 and 48.0± 15.8 ml·min 1 ·[1.73 m2]-1,respectively) than brain trauma group (62.5 ± 14.2,64.1 ± 13.9 and 69.1 ± 14.9 ml·min1 · [1.73 m2]-1,respectively).During a follow-up period of 3～28 months,the acturial graft survival rate of HCH group and brain trauma group was 92.6％ (25/27) and 100％ (38/38),respectively (P＞0.05).Conclusion The eGFR of renal grafts from HCH donors was significantly lower than that of the grafts from brain trauma donors,and the allografts from HCH donors showed accelerated deterioration in function in the first year after transplantation.The kidneys from HCH donors should be biopsied before implantation and allocated preferably to older recipients with lower body mass index. Key words: Hypertensive; Cerebral hemorrhage; Donation after cardiac death; Kidney transplantation