Kidneys recovered from deceased donors with acute renal failure (ARF) - once deemed unusable for transplant - appear to work just as well as kidneys transplanted from deceased donors who do not develop kidney problems prior to organ donation, according to a new study by researchers at Wake Forest University Baptist Medical Center.
The findings, reported in the October issue of Surgery, suggest the possibility of safely expanding the donor kidney pool by at least 10 to 15 percent, potentially making an additional 1,000 kidneys or more per year available to those waiting for a donor organ.
"There is a critical shortage of donor organs and we are continually making efforts to expand the donor pool," said Robert J. Stratta, M.D., professor of surgery and director of transplantation at Wake Forest Baptist and senior investigator on the study. "While kidneys from deceased donors with ARF have been considered unusable in the past, our study shows they can work quite well. The function of the new kidney may be slow or delayed - and patients may have to continue dialysis for a week or two until the kidney is up and running - but that's really the only downside. Choosing to utilize these kidneys will greatly shorten the waiting time for people who are willing to accept a kidney from this kind of donor."
Stratta and colleagues transplanted 25 kidneys from 17 deceased donors with ARF, which is impaired kidney function that can result from many things, including traumatic injury, exposure to medications toxic to the kidneys, infection, dehydration, shock, and the breakdown of muscle fibers. Unlike chronic kidney failure, ARF can often be reversed if the underlying cause is treated or removed, Stratta said.
All of the kidneys were refused by multiple centers before being offered for transplantation at Wake Forest Baptist. The patients receiving the kidneys had an average waiting time of 24 months until a donor kidney was made available to them and each chose to accept the organ. All of the recipients were monitored for at least 11 months post-transplant. At an average follow-up of 20 months, patient and graft survival rates were 100 percent and 92 percent, respectively - comparable, Stratta said, to the outcomes typically seen when healthy deceased donor kidneys are transplanted.
"As long as the donor kidneys are still producing urine and do not have evidence of scarring from pre-existing conditions such as diabetes or a history of high blood pressure, they appear to restore to a healthy condition when transplanted," he said.