Successful Kidney Transplantation using Deceased Donor Kidney with Acute Tubular Necrosis

Abstract

We present here a case of success kidney transplantation from a deceased donor who showed a serum creatinine level of 5.5 mg/dl. A 52-year-old Asian female with blood type O was determined to be brain death after a compressive craniectomy. Her post-operative course was fatal. She had experienced acute renal failure with oliguria, and these conditions had persisted for 3 days, and the serum creatinine level was elevated up to 5.5 mg/dl. The random urine creatinine, sodium and osmolarity levels were 17.6 mg/dl, 116 mmol/L and 346 mOsmol/L, respectively. However, the ultrasonographic and pathologic findings did not show any chronic structural abnormality in the kidneys. Two female patients with blood type O were transplanted with these donor kidneys. Both recipients experienced 2∼3 days of delayed graft function, but the graft function was fully recovered at 4∼5 day after transplantation. Both recipients were discharged with full-functioning grafts (1.1 and 0.9 mg/dl of serum creatinine, respectively). This shows that a deceased donor with reversible kidney damage, and even one showing a high serum creatinine level, can be acceptable for transplantation if the absence of chronic renal damage is confirmed by pathologic study