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
TAKE HOME Message
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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