Kidney Transplantation from an extracorporeal membrane oxygenation-supported brain-dead donor: A case report

RATIONALE: 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. PATIENT CONCERNS: Kidney transplantation from an ECMO-supported DBD. DIAGNOSES: We found an extremely abnormal “very dark blue” appearance of the graft kidneys from an ECMO-supported DBD during kidney procurement. INTERVENTIONS: 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. OUTCOMES: Two candidates received graft kidneys, and the two grafts remained functional until the 8-month follow-up. LESSONS: 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.