Kidney Transplantation Using High-Vascular-Resistant Renal Allografts From a Donor Who Had Calcineurin-Induced Functional Acute Kidney Injury.

Background: High renal vascular resistance (RR) during hypothermic machine perfusion (HMP) is a common cause for declining renal allografts for transplantation. We report 2 kidney allografts with high RR that were successfully used for transplantation.

Donor data: Two kidneys were procured from a 34-year-old female donation after circulatory death (DCD) donor with functional acute kidney injury (AKI) due to high-dose chronic calcineurin inhibitor (CNI) therapy. The donor had 56 minutes of warm ischemic time (WIT) and was connected to the HMP. After 29 hours of HMP, the RR of the right and left kidneys were 0.83 and 0.70 mm Hg/mL/min, respectively. The donor's terminal serum creatinine (Cr) was 0.83 mg/dL, and urine output decreased from 101 mL/hour to 16.5 mL/hour 3 days prior to organ recovery. Both kidneys were accepted for transplantation.

Results: Both kidneys were successfully transplanted, with recipients discharged home on postoperative days 4 and 5 without oliguria. The preimplant high RR on HMP was likely due to tacrolimus-induced reversible AKI. The right kidney recipient's Cr values were 4.4 mg/dL preimplant, 3.6 mg/dL at discharge, and 2.4 mg/dL 1 year posttransplant. The left kidney recipient's Cr values were 7.2, 7.6, and 3.3 mg/dL, respectively. The cold ischemic time (CIT) for the right and left allografts was 47.2 and 42.8 hours, respectively. The left kidney experienced delayed graft function (DGF), requiring 1 dialysis treatment postoperatively. Neither recipient required dialysis after discharge.

Conclusion: Kidney allografts with high RR during HMP, from donors with CNI drug-induced functional AKI, can be successfully used for transplantation.