使用一位葉克膜維生的腦死病患所捐贈的”深紫色”腎臟進行腎臟移植
江佩璋、唐守宏、李蕎青、周孟翰、林佑俊1、吳勝堂
三軍總醫院 外科部 泌尿外科，1病理部
Kidney transplantation using “deep-purple” graft kidneys from an extracorporeal membrane oxygenation-supported brain-dead donor
Pei-Jhang Chiang, Shou-Hung Tang, Chiao-Ching Li, Meng-han Chou, Lin, Yu-Chun1, Sheng-Tang Wu
Division of Urology, Department of Surgery and Department of Pathology1, Tri-Service General Hospital,
National Defense Medical Center, Taipei, Taiwan, R.O.C
Introduction: Extracorporeal membrane oxygenation (ECMO)-supported brain-dead donors have been used as extended criteria donors in our previous report. However, pre-transplant biopsy could be more important than the gross appearance or serum creatinine (SCr) level at donation to determine the possibility to use such donors.
Case report: The donor is a 39-year-old male trauma patient, who has been put on an ECMO during resuscitation. This donation was made at 21 days after his trauma, 7 days after the ECMO was placed on. The initial SCr on admission was 0.9 mg/dL and rose to 4.7 mg/dL at harvesting. During kidney procuration, we found an extremely abnormal appearance of his kidneys which was “deep-purple” in color. Rather than discarding the kidneys, we proceeded to an on-table biopsy.
Microscopically, the section showed only minimal interstitial fibrosis (Grade 1/12), and the glomeruli were reported to be intact. After informed consent, two candidates received either grafts: a 47-year-old female and a 58-year-old female who was diagnosed with end-stage renal disease due to lupus nephritis and IgA nephropathy, respectively. Although both recipients developed delayed graft function, these two grafts remained functioning at the 6-month follow-up.
Conclusion: It has always been a challenge for surgeons to decide whether to use or discard marginal donor kidneys. Preoperative evaluation and intra-operative frozen section consultation may play an important role in ECMO-supported donation. Long-term follow-up is required to confirm the benefit of our practice.