Renal Transplantation of Discolored Kidneys from Donors with Rhabdomyolysis and Acute Kidney Injury

Abstract

Background Rhabdomyolysis is common in trauma patients with acute renal injury (AKI). The kidneys from donors with rhabdomyolysis and AKI may show discolored appearance. The transplant surgeons may be unwilling to accept a kidney with AKI and black appearance, especially when the kidney is anuric. Method Fourteen discolored (from brown to glossy black) kidneys from 7 deceased donors with severe rhabdomyolysis and AKI (defined as Kidney Disease Improving Global Outcomes (KDIGO) AKI Stage 1 - 3) were accepted for transplantation at our centers. Generally, we accept kidneys with a resistance < 0.4 mmHg/mL/min in pump perfusion when an preimplant biopsy excludes cortical necrosis and chronic lesions (>10% glomerulosclerosis, interstitial fibrosis, tubular atrophy). The kidney transplant results of 14 black kidneys from rhabdomyolysis donors were compared with those of 30 renal grafts from standard criteria donors (SCD). Results Two donors received continuous renal replacement therapy due to anuria. The peak serum creatinine kinase, myoglobin, and serum creatinine of the these donors was 27738 ± 7394 U/L, 76003 ± 50708 μg/L, and 442 ± 214 μmol/L, respectively. Pathological examination showed massive casts in the distal convoluted tubules. Immunohistochemically stained for myoglobin showed luminal myoglobin casts or prominent tubular epithelial cell reaction for myoglobin in the absence of luminal casts. Electron microscopy showed electron-dense casts consistent with myoglobin within tubular lumens. The estimated glomerular filtration rate (by the CKD-EPI Creatinine 2009 equation) at 1 years post-transplantation was similar between black kidneys from donors with rhabdomyolysis and SCD (69.8 ± 13.6 ml/min/1.73m2 vs. 71.2 ± 15.1 ml/min/1.73m2, P = 0.56). Conclusion If the rhabdomyolysis donor has a peak serum creatinine kinase level higher than 20 000 U/L and has tea- colored urine, the kidneys are likely to have a black appearance after in situ cold perfusion. Discolored kidneys from rhabdomyolysis donors with AKI can achieve excellent graft function, even when the kidneys are anuric. Routine screening for rhabdomyolysis should be performed in donors with AKI.