Chiang Pei-Jhang, Tang Shou-Hung, Li Chiao-Ching, Chou Meng-Han, Lin Yu-Chun, Wu Sheng-Tang
Division of Urology, Department of Surgery Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Nei-Hu, Taipei, Taiwan.
Medicine (Baltimore). 2018 Jun;97(26):e11106. doi: 10.1097/MD.0000000000011106.
Extracorporeal membrane oxygenation (ECMO) can deliver effective respiratory and circulatory maintenance to organ donors, improve organ function, and shorten warm ischemic time before harvesting. However, ECMO-supported brain-dead donors (DBDs) still have a high risk of acute kidney injury related to decreased renal oxygen delivery and inflammatory damage, which may cause early graft failure.
Kidney transplantation from an ECMO-supported DBD.
We found an extremely abnormal "very dark blue" appearance of the graft kidneys from an ECMO-supported DBD during kidney procurement.
Rather than discarding the graft kidneys, we performed an on-table biopsy. Pretransplant biopsy results revealed minimal interstitial fibrosis in the section of these graft kidneys.
Two candidates received graft kidneys, and the two grafts remained functional until the 8-month follow-up.
Currently, there is no standard method for evaluating graft kidney function of ECMO-supported DBDs. Regardless of the donors' preoperative serum creatinine (SCr) level, estimated glomerular filtration rate (eGFR), or gross appearance of the graft kidney, we believe that it is more reliable to include pretransplant biopsy as a criterion in clinical practice to safely accept kidneys from ECMO-supported DBDs.
体外膜肺氧合（ECMO）可为器官捐献者提供有效的呼吸和循环维持，改善器官功能，并缩短获取前的热缺血时间。然而，接受ECMO支持的脑死亡供者（DBD）仍有较高风险发生与肾脏氧输送减少和炎症损伤相关的急性肾损伤，这可能导致早期移植肾失功。
接受来自接受ECMO支持的DBD的肾移植。
在获取肾脏过程中，我们发现来自接受ECMO支持的DBD的移植肾外观呈现极其异常的“深蓝色”。
我们没有丢弃移植肾，而是进行了术中活检。移植前活检结果显示这些移植肾切片中的间质纤维化程度轻微。
两名受者接受了移植肾，两个移植肾在8个月的随访期内均保持功能。
目前，尚无评估接受ECMO支持的DBD的移植肾功能的标准方法。无论供者术前血清肌酐（SCr）水平、估算肾小球滤过率（eGFR）或移植肾的大体外观如何，我们认为在临床实践中将移植前活检作为一项标准纳入，对于安全接受来自接受ECMO支持的DBD的肾脏更为可靠。
