Skip to main content

Advertisement

SpringerLink
Log in

Kidney transplantation from deceased donors with elevated serum creatinine

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Elevated donor serum creatinine has been associated with inferior graft survival in kidney transplantation (KT). The aim of this study was to evaluate the impact of elevated donor serum creatinine on short and long-term outcomes and to determine possible ways to optimize the use of these organs.

Methods

All kidney transplants from 01–2000 to 12–2012 with donor creatinine ≥ 2 mg/dl were considered. Risk factors for delayed graft function (DGF) were explored with uni- and multivariate regression analyses. Donor and recipient data were analyzed with uni- and multivariate cox proportional hazard analyses. Graft and patient survival were calculated using the Kaplan-Meier method.

Results

Seventy-eight patients were considered. Median recipient age and waiting time on dialysis were 53 years and 5.1 years, respectively. After a median follow-up of 6.2 years, 63 patients are alive. 1, 3, and 5-year graft and patient survival rates were 92, 89, and 89 % and 96, 93, and 89 %, respectively. Serum creatinine level at procurement and recipient’s dialysis time prior to KT were predictors of DGF in multivariate analysis (p = 0.0164 and p = 0.0101, respectively). Charlson comorbidity score retained statistical significance by multivariate regression analysis for graft survival (p = 0.0321). Recipient age (p = 0.0035) was predictive of patient survival by multivariate analysis.

Conclusions

Satisfactory long-term kidney transplant outcomes in the setting of elevated donor serum creatinine ≥2 mg/dl can be achieved when donor creatinine is <3.5 mg/dl, and the recipient has low comorbidities, is under 56 years of age, and remains in dialysis prior to KT for <6.8 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AKI:

acute kidney injury

BMI:

body mass index

CIT:

cold ischemic time

CMV:

cytomegalovirus

CPR:

cardiopulmonary resuscitation

DGF:

delayed graft function

DCD:

donor after cardiac death

ECD:

extended criteria donor

HLA:

human leukocyte antigen

HTK:

histidine-tryptophane-ketoglutarate

ICU:

intensive care unit

IGF:

immediate graft function

KT:

kidney transplantation

ROC:

receiver operating characteristic

UW:

University of Wisconsin

WIT:

warm ischemia time

References

  1. Mayer G, Persijn GG (2006) Eurotransplant kidney allocation system (ETKAS): rationale and implementation. Nephrol Dial Transplant 21:2–3

    Article  PubMed  Google Scholar 

  2. Ahlert M, Kliemt H (2013) Problems of priority change in kidney allocation and beyond. Eur J Health Econ 14:383–390

    Article  PubMed  Google Scholar 

  3. Glander P, Budde K, Schmidt D, Fuller TF, Giessing M, Neumayer HH, Liefeldt L (2010) The “blood group O problem” in kidney transplantation—time to change? Nephrol Dial Transplant 25:1998–2004

    Article  PubMed  Google Scholar 

  4. Palmes D, Wolters HH, Brockmann J, Senninger N, Spiegel HU, Dietl KH (2004) Strategies for compensating for the declining numbers of cadaver donor kidney transplants. Nephrol Dial Transplant 19:952–962

    Article  PubMed  Google Scholar 

  5. Gallinat A, Feldkamp T, Schaffer R, Radünz S, Treckmann JW, Minor T, Witzke O, Paul A, Sotiropoulos GC (2011) Single-center experience with kidney transplantation using deceased donors older than 75 years. Transplantation 92:76–81

    Article  PubMed  Google Scholar 

  6. Gallinat A, Paul A, Minor T, Treckmann JW, Molmenti EP, Witzke O, Sotiropoulos GC (2012) Optimized outcomes for renal allografts with cold ischemic times of 20 h or greater. Int Urol Nephrol 44:1417–1423

    Article  PubMed  Google Scholar 

  7. Gallinat A, Sotiropoulos GC, Witzke O, Treckmann JW, Molmenti EP, Paul A, Vester U (2013) Kidney grafts from donors ≤ 5 yr of age: single kidney transplantation for pediatric recipients or en bloc transplantation for adults? Pediatr Transplant 17:179–184

    Article  PubMed  Google Scholar 

  8. Gallinat A, Moers C, Treckmann J, Smits JM, Leuvenink HG, Lefering R, van Heurn E, Kirste GR, Squifflet JP, Rahmel A, Pirenne J, Ploeg RJ, Paul A (2012) Machine perfusion versus cold storage for the preservation of kidneys from donors ≥ 65 years allocated in the Eurotransplant Senior Programme. Nephrol Dial Transplant 27:4458–4463

    Article  PubMed  Google Scholar 

  9. Gallinat A, Paul A, Efferz P, Lüer B, Swoboda S, Hoyer D, Minor T (2012) Role of oxygenation in hypothermic machine perfusion of kidneys from heart beating donors. Transplantation 94:809–813

    Article  CAS  PubMed  Google Scholar 

  10. Gallinat A, Lüer B, Swoboda S, Rauen U, Paul A, Minor T (2013) Use of the new preservation solution Custodiol-N supplemented with dextran for hypothermic machine perfusion of the kidney. Cryobiology 66:131–135

    Article  CAS  PubMed  Google Scholar 

  11. Gallinat A, Moers C, Smits JM, Strelniece A, Pirenne J, Ploeg RJ, Paul A, Treckmann J (2013) Machine perfusion versus static cold storage in expanded criteria donor kidney transplantation: 3-year follow-up data. Transpl Int 26:E52–53

    Article  PubMed  Google Scholar 

  12. Gallinat A, Paul A, Efferz P, Lüer B, Kaiser G, Wohlschlaeger J, Treckmann J, Minor T (2012) Hypothermic reconditioning of porcine kidney grafts by short-term preimplantation machine perfusion. Transplantation 93:787–793

    Article  CAS  PubMed  Google Scholar 

  13. Treckmann J, Moers C, Smits JM, Gallinat A, Maathuis MH, van Kasterop-Kutz M, Jochmans I, Homan van der Heide JJ, Squifflet JP, van Heurn E, Kirste GR, Rahmel A, Leuvenink HG, Pirenne J, Ploeg RJ, Paul A (2011) Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death. Transpl Int 24:548–554

    Article  PubMed  Google Scholar 

  14. Gallinat A, Fox M, Lüer B, Efferz P, Paul A, Minor T (2013) Role of pulsatility in hypothermic reconditioning of porcine kidney grafts by machine perfusion after cold storage. Transplantation 96:538–542

    Article  PubMed  Google Scholar 

  15. Nagelschmidt M, Minor T, Gallinat A, Moers C, Jochmans I, Pirenne J, Ploeg RJ, Paul A, Treckmann J (2013) Lipid peroxidation products in machine perfusion of older donor kidneys. J Surg Res 180:337–342

    Article  CAS  PubMed  Google Scholar 

  16. Lopes JA, Moreso F, Riera L, Carrera M, Ibernon M, Fulladosa X, Grinyó JM, Serón D (2005) Evaluation of pre-implantation kidney biopsies: comparison of Banff criteria to a morphometric approach. Kidney Int 67:1595–1600

    Article  PubMed  Google Scholar 

  17. Roodnat JI, Mulder PG, Van Riemsdijk IC, IJzermans JN, van Gelder T, Weimar W (2003) Ischemia times and donor serum creatinine in relation to renal graft failure. Transplantation 75:799–804

    Article  CAS  PubMed  Google Scholar 

  18. Parzanese I, Maccarone D, Caniglia L, Pisani F, Mazzotta C, Rizza V, Famulari A (2006) Risk factors that can influence kidney transplant outcome. Transplant Proc 38:1022–1023

    Article  CAS  PubMed  Google Scholar 

  19. Wu WK, Famure O, Li Y, Kim SJ (2015) Delayed graft function and the risk of acute rejection in the modern era of kidney transplantation. Kidney Int 88:851–858

    Article  CAS  PubMed  Google Scholar 

  20. Ugarte R, Kraus E, Montgomery RA, Burdick JF, Ratner L, Haas M, Hawxby AM, Karp SJ (2005) Excellent outcomes after transplantation of deceased donor kidneys with high terminal creatinine and mild pathologic lesions. Transplantation 80:794–800

    Article  CAS  PubMed  Google Scholar 

  21. Morgan C, Martin A, Shapiro R, Randhawa PS, Kayler LK (2007) Outcomes after transplantation of deceased-donor kidneys with rising serum creatinine. Am J Transplant 7:1288–1292

    Article  CAS  PubMed  Google Scholar 

  22. Lin NC, Yang AH, King KL, Wu TH, Yang WC, Loong CC (2010) Results of kidney transplantation from high-terminal creatinine donors and the role of time-zero biopsy. Transplant Proc 42:3382–3386

    Article  CAS  PubMed  Google Scholar 

  23. Kolonko A, Chudek J, Pawlik A, Wilk J, Jałowiecki P, Więcek A (2011) Acute kidney injury before organ procurement is associated with worse long-term kidney graft outcome. Transplant Proc 43:2871–2874

    Article  CAS  PubMed  Google Scholar 

  24. Zuckerman JM, Singh RP, Farney AC, Rogers J, Stratta RJ (2009) Single center experience transplanting kidneys from deceased donors with terminal acute renal failure. Surgery 146:686–694

    Article  PubMed  Google Scholar 

  25. Bacak-Kocman I, Peric M, Kastelan Z, Kes P, Mesar I, Basic-Jukic N (2013) First documented case of successful kidney transplantation from a donor with acute renal failure treated with dialysis. Int Urol Nephrol 45:1523–1526

    Article  PubMed  Google Scholar 

  26. Heilman RL, Smith ML, Kurian SM, Huskey J, Batra RK, Chakkera HA, Katariya NN, Khamash H, Moss A, Salomon DR, Reddy KS (2015) Transplanting kidneys from deceased donors with severe acute kidney injury. Am J Transplant 15:2143–2151

    Article  CAS  PubMed  Google Scholar 

  27. Riethmüller S, Ferrari-Lacraz S, Müller MK, Raptis DA, Hadaya K, Rüsi B, Laube G, Schneiter G, Fehr T, Villard J (2010) Donor-specific antibody levels and three generations of crossmatches to predict antibody-mediated rejection in kidney transplantation. Transplantation 90:160–167

    Article  PubMed  Google Scholar 

  28. Tait BD, Süsal C, Gebel HM, Nickerson PW, Zachary AA, Claas FH, Reed EF, Bray RA, Campbell P, Chapman JR, Coates PT, Colvin RB, Cozzi E, Doxiadis II, Fuggle SV, Gill J, Glotz D, Lachmann N, Mohanakumar T, Suciu-Foca N, Sumitran-Holgersson S, Tanabe K, Taylor CJ, Tyan DB, Webster A, Zeevi A, Opelz G (2013) Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation. Transplantation 95:19–47

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany

    Anja Gallinat, Sabine Leerhoff, Andreas Paul, Maren Schulze & Georgios C. Sotiropoulos

  2. Department of Nephrology, University Hospital Essen, Essen, Germany

    Oliver Witzke

  3. Department of Surgery, North Shore University Hospital, Manhasset, NY, USA

    Ernesto P. Molmenti

Authors
  1. Anja Gallinat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabine Leerhoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ernesto P. Molmenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maren Schulze
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oliver Witzke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Georgios C. Sotiropoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georgios C. Sotiropoulos.

Ethics declarations

Conflict of interest

The authors declare no financial support and no conflict of interest.

Additional information

Statement

The authors of this manuscript declare that the results presented in this paper have not been published previously in whole or part except in abstract format.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gallinat, A., Leerhoff, S., Paul, A. et al. Kidney transplantation from deceased donors with elevated serum creatinine. Langenbecks Arch Surg 401, 1211–1217 (2016). https://doi.org/10.1007/s00423-016-1445-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-016-1445-9

Keywords

Search

Navigation