Impact of diseased Donors’ Serum Creatinine Level on Outcome of transplanted Kidneys: The Use of Personalized Medicine for Patient Selection

Introduction: One of the possibilities is the utilize of personalized medicine, a method based on quantifiable and theoretical agents that assign the worldwide immunological hazard of refusal for each patient. Kidney transplantation is the best treatment for end-stage renal disease patients. Although the shortage of kidneys for transplantation has been addressed by expanding the criteria, transplantation teams in Iran don’t have great tendency to implant marginal organs from brain death donors specially the ones with high creatinine before harvesting. The aim of this study was to evaluate the impact of brain dead donor serum creatinine (Cr) level on outcome of transplanted kidneys. Methods: In this retrospective study, the records of 46 brain-dead donors of Masih Daneshvari organ procurement unit of Tehran, Iran were assessed. The medical file of donated 58 recipients was available. Donor demographic data (age, sex), brain death cause and the Cr level after transferring to OPU ICU were recorded. The Cr level was categorized based on ≥1.4 mg/dl with origin of prerenal azotemia or lower. The urine output of transplanted patients in the first 24 hours post-transplant, serum Cr level at discharge from hospital and dialysis during first month after transplantation were compared between two groups. Results: The mean age of donors was 37yr and 25 (54%) were male. The cause of brain death in 16 (35%) was trauma. The donors’ creatinine level at the admission to the ICU was 1.4mg/dl or higher in 20 (35%). The first 24 hours urine output did not significantly differ between donors’ creatinine level lower than 1.4mg/dl or higher (5500 ± 2678ml and 4068 ± 3399ml, respectively, P=0.083). Similarly the recipient discharge serum Cr level did not significantly differ between two groups (1.69 ± 0.97 and 1.74 ± 1.34 mg/dl, respectively, P=0.887). Overall 8 recipients (14%) needed dialysis during first month after transplantation and there was no significant difference between groups (11% and 20%, respectively, P = 0.320).
Conclusions: Findings of this preliminary study showed that the outcome of transplanted kidneys from brain-dead donors with Cr level >=1.4mg/dl is similar to other patients. So, higher creatinine level is not a good excuse for rejecting the kidneys for transplantation. Because of various confounding factors in the assessment of transplanted kidney outcome, the future studies with larger sample size and longer follow-up period is recommended.