Kidney Transplantation From a Deceased Donor With Anuric Acute Kidney Injury

Caused by Rhabdomyolysis

Dr. Sarah Leyking Innere Medizin IV, Nephrologie

Uniklinik Homburg

DGU 13.11.2015

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Eurotransplant Kidney Offer

21 years old man

suicidal medication overdose of baclofen and alcohol

cardiopulmonary resuscitation

rhabdomyolysis

CVVHD

anoxic brain damage

Several centers rejected the kidneys

Case Report

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Donor Data

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Recipient Data

Caucasian female

Delayed graft function and dialysis on days 1 and 3 postoperatively

Biopsy: Acute tubular necrosis and pathognomonic myoglobin deposition

Creatinine:

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Rhabdomyolysis and AKI

Melli et al. Rhabdomyolysis: an evaluation of 475 hospitalized patients. 2005 Medicine

Definition Rhabdomyolysis: CK>975 5-fold >5000 myoglobinuria n.n. n.n. n.n.

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Rhabdomyolysis and AKI

Melli et al. Rhabdomyolysis: an evaluation of 475 hospitalized patients. 2005 Medicine

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AKI and Transplantation

Greenstein et al. Excellent outcome using ‘‘impaired’’ SC donors with elevated creatinine. 2008 Clin Transpl

at nephrectomy at 6-months

Mean recipient S.Cr

Mean recipient S.Cr

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AKI and Transplantation

Klein et al. Transplantation From Donors With Acute Renal Failure. 2013 Transplantation

expanded-criteria donor standard-criteria donor

with AKI with AKI

without AKI without AKI

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Summary

• AKI due to rhabdomyolysis is common

• A very weak correlation between the peak creatine kinase value and peak serum creatinine

• majority recover renal function

• More delayed graft function than in transplanted patients with non-AKI donors

• The long-term outcome seems comparable

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Even kidneys with severe AKI

should be considered for transplantation,

when donors are young

without pre-existing chronic renal damage

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Vielen Dank für die Aufmerksamkeit

Urologie Nephrologie

Prof. Michael Stöckle Dr. Carsten Ohlmann

Prof. Danilo Fliser Dr. Matthias Klingele Prof. Urban Sester Aaron Poppleton

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Rhabdomyolysis and AKI

Melli et al. Rhabdomyolysis: an evaluation of 475 hospitalized patients. 2005 Medicine