Abstract
The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation. All of the transplants performed in two university hospitals between 2010and 2017were analyzed retrospectively. All patients who underwent single kidney transplant from a brain-dead donor with acute renal failure (ARF) were included in this study. ARI was defined here by a decrease over 50% of glomerular filtration rate (GFR) to a threshold below 45mL/min/1.73m2at the time of kidney procurement. Kidney graft survival, incidence of delayed graft function (DGF) and the GFR at 12months were analyzed. Analysis of kidney transplant survival based on pre-implantation biopsies was additionally done. One hundred and sixty four patients were transplanted with a kidney from donor with ARF during the selected period. At the admission in ICU the average GFR was 67,7±19mL/min/1,73m2. At the time of donation, the average age of donors was 56.4±17.7years, the GFR was 33.7±8.0mL/min/1.73m2 16% of donors were anuric. Cold ischemia time (CIT) was 16.8±5.0hours. The average age of recipients was 55.6±14.1years. 81% of the cases were primary transplants. Graft function took place within 7.8±9.4days after transplantation. There were two non-primary functions (PNF). One hundred and fifty two patients (93%) had a functional graft at 12months. The mean GFR at 12months was 46.8±20.1mL/min/1.73m2and 122patients (73%) had a GFR greater than 30mL/min/1.73m2. Seventy-one percent of preimplantation biopsies revealed acute tubular necrosis (ATU); no cortical necrosis was observed. Survival of theses grafts was 85%, comparable to the total population of study (P=0,21) CONCLUSION: The acute renal failure of the brain-dead donor should not alone be systematically a contraindication to harvesting and kidney transplantation.
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