The benefits of initiating continuous renal replacement therapy after brain death in organ donors with oligoanuric acute kidney injury

Abstract

Acute kidney injury (AKI) in deceased organ donors is increasing due to the escalation in anoxic brain‐deaths. The management of an organ donor with oligoanuric AKI is frequently curtailed due to hemodynamic and electrolyte instability. Although continuous renal replacement therapy (CRRT) corrects the effects of AKI, it is rarely started after the diagnosis of brain‐death (BD). Since 2017, we have initiated CRRT in organ donors with oligoanuric AKI to allow more time to stabilize the donor and improve the function of the thoracic organs. We now report our experience with the first 27 donors with oligoanuric AKI that received CRRT after the diagnosis of BD, with organs transplanted as the primary outcome. The average duration of CRRT was 30.1 ± 14.4 h and the mean ultrafiltration volume was 5141 ± 4272 ml. The time from BD declaration to cross clamp was significantly longer in the CRRT group versus a historical cohort with oligoanuric AKI that was not dialyzed (62.8 ± 18.3 vs. 37.1 ± 14.9 h; P < .01). The mean number of total organs transplanted per donor in the CRRT group was greater than the historical cohort, 2.9 ± 1.7 vs. 1.4 ± .6 (P = .< 01), respectively. The mean number of thoracic organs transplanted per donor also increased between the two groups, 1.4 ± 1.2 versus .6 ± .9 (P = .02). Thirty‐seven percent of the kidneys were successfully transplanted with a mean serum creatinine of 1.4 mg/dl at 6 months. We suggest that OPOs consider starting CRRT in organ donors with oligoanuric AKI to possibly increase the number of organs transplanted.

Dialyzing Brain-Dead for Organ Procurement

“…To address the organ donation pool shortage, strategies have been developed to optimize the procurement of organs from brain-dead patients, like extracorporeal life support [ 13 , 14 ]. Specifically with the kidneys, however, kidney replacement therapy is rarely started after the diagnosis of brain death to treat the donor’s AKI [ 15 ]. Although not well studied, two kidney replacement therapies are currently present for kidney procurement from the brain-dead: continuous kidney replacement therapy (CKRT) and extracorporeal kidney replacement therapy [ 15 ].…”

“…Specifically with the kidneys, however, kidney replacement therapy is rarely started after the diagnosis of brain death to treat the donor’s AKI [ 15 ]. Although not well studied, two kidney replacement therapies are currently present for kidney procurement from the brain-dead: continuous kidney replacement therapy (CKRT) and extracorporeal kidney replacement therapy [ 15 ].…”

Effects of continuous renal replacement therapy on Apache-II score, creatinine, and urea nitrogen levels in patients with acute kidney injury

“…6 It allows timely and efficient removal of inflammatory mediators, thus restoring electrolyte balance. 7 In the current study, we use clinical efficacy, survival rate, disease severity, renal function level and serum electrolytels and fluid balance as evaluation indexes to retrospectively analyze the application effect of CRRT in treating patients with AKI.…”

“… 6 It allows timely and efficient removal of inflammatory mediators, thus restoring electrolyte balance. 7 …”