2010 - TTS International Congress


Kidney Sensitized Patients

53.8 - Long term renal allograft outcomes using deceased donor kidneys from cobra bite brain dead donors – a case series

Presenter: Yuvaram, Reddy, Chennai, India
Authors: Abraham G., Reddy Y., Shroff S., S. M., Mathew M., Reddy Y.


LONG TERM RENAL ALLOGRAFT OUTCOMES USING DECEASED DONOR KIDNEYS FROM COBRA BITE BRAIN DEAD DONORS – A CASE SERIES

KIDNEY - SENSITIZED PATIENTS

G. Abraham1, Y. Reddy1, S. Shroff2, M. S.2, M. Mathew1, Y. Reddy2
1Dialysis And Renal Transplantation, Madras Medical Mission, CHENNAI/INDIA, 2Nephrology, Sri Ramachandra University, Chennai/INDIA

Body: Introduction:The crude and age adjusted incidence rates of ESRD are estimated to be 151 and 232 per million population respectively in India. The rate of renal transplantation is 3.25 per million population in India with 0.08 per million population coming from deceased donors. This huge shortage of organs for renal transplantation has lead to the exploration of poisoned marginal donors such as those from cobra bite envenomation to alleviate the shortage. The safety of this approach has not been adequately studied. Here we present the long term experience of having used deceased donor kidneys from two cobra bite envenomation victims, which were successfully transplanted in three diabetic adult recipients and one non diabetic recipient in Chennai,India. Case Report:The two male donors aged 12 and 22 years from remote village were admitted after cobra bite in the hands, with profound neurological damage in 1996 and 1999 respectively. Polyvalent antivenom was used to neutralize the snake venom.However the envenomation produced irreversible brain damage leading to brain death (certified after four to five days of stay in the ICU). Both of them had normal renal function. Two diabetic recipients survived for 16 and 22 months and the third diabetic is doing well for last 167 months and the fourth recipient was lost to follow up after 25 months. The 63 year old male developed a steroid resistant biopsy proven acute cellular rejection and was successfully treated with 5 mg of OKT3 for 5 days and his creatinine came down subsequently to 0.9mg/dl. He developed a pulmonary embolism with infarction 2 weeks later which required anticoagulation with heparin. All four patients received prednisolone 1mg/kg, azathioprine 2mg/kg and microemulsion form of cyclosporine 8mg/kg in divided doses. No specific induction therapy with antibodies was given. Table 1- Basic Demography and outcome of recipients:

Recipient age/gender Original disease Donor age/gender Cold/Warm ischemia time Rejection episodes Graft survival Cause of death Immunosuppressive agents
52/female DN 12/male 10 hours/ 45 minutes Nil 167 months Alive Prednisolone + azathioprine
36/female Unknown 6 hours/ 30 minutes Nil Lost to follow up after 25 months with functioning graft - Prednisolone + azathioprine + cyclosporine
63/ male DN 22/male 6 hours/ 35 minutes One SR One dialysis 16 months Sepsis Prednisolone+ azathioprine + cyclosporine
61/male DN 9 hours/ 40 minutes One rejection 22 months Sepsis Prednisolone+ azathioprine + cyclosporine

DN- diabetic nephropathy, SR- steroid resistant Conclusion: In our experience the functioning grafts suggest that cobra bite brain dead donors can be successfully used for kidney donation. The death due to sepsis in our two diabetic recipients 16 months and 22 months after transplantation is not uncommon in the Indian setup as these recipients were diabetic with diabetic complications. The long term survival of the currently aged 66 year old diabetic lady over 14 years with good graft function and minimal immunosuppression is proof of the fact that kidneys from brain dead cobra bite victims can be successfully used for transplantation. In conclusion, in countries with organ shortage for renal transplantation, cobra bite brain dead victims with normal kidney function can be used as potential donors as exemplified in our case series

Disclosure: All authors have declared no conflicts of interest.


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