Reuse of a Transplanted Kidney

Abstract

Pasic et al. (Feb. 4 issue)1 report the successful reuse of a transplanted heart. In our hospital, Moreno et al.2 reused a liver graft with a favorable result. Recently, we reused a transplanted kidney with a beneficial outcome. The kidney donor was a 22-year-old man with brain death due to cerebral hemorrhage. The first recipient was a 39-year-old man with end-stage renal disease due to diabetic nephropathy. In August 1992 renal transplantation was performed at another hospital. The cold-ischemia time was 20 hours. After reperfusion, diuresis began, and the patient's renal function improved. The patient was treated with azathioprine, prednisone, cyclosporine, and OKT3 monoclonal antibody. On the eighth postoperative day he had an intracranial hemorrhage and was pronounced brain-dead. Reuse of the transplanted kidney was considered. The graft was removed and sent to our center. The second recipient was a 39-year-old man with end-stage renal disease due to chronic glomerulonephritis. The cold-ischemia time was eight hours. After reperfusion, the patient underwent diuresis and his serum creatinine level decreased. The immunosuppressive protocol included prednisone, azathioprine, cyclosporine, and a cycle of horse antithymocyte globulin. Table 1Table 1Characteristics of the Kidney Donor and Both Recipients. shows HLA matching and the serum creatinine levels of the donor and recipients. There is a long waiting list for transplantation in both Europe and the United States3,4. If a transplanted kidney works in one patient, it may work in a second patient. Two periods of cold ischemia and immunologic problems may make a graft less likely to be viable. Our patient had immediate renal function with no episodes of rejection. On the basis of our experience, we recommend that more consideration be given to the reuse of transplanted solid organs in appropriate circumstances. Therefore, we should carefully evaluate all potential donors of solid organs, including transplant recipients whose grafts can be reused.