Primary non-function in a deceased donor kidney transplant even with a Kidney Donor Risk Index less than 1.0: a case report

Donations from deceased donors have been increasing since the introduction of expanded criteria for donor kidney selection. Several studies have shown that patients receiving deceased donor kidneys using these expanded criteria have improved survival compared to those remaining on the waiting list during hemodialysis. It is important, however, to consider that some of the kidneys classed as usable under the expanded criteria may in fact be unacceptable. To address this concern, preoperative biopsy and imaging of deceased donor kidneys are increasingly being used to assess candidate kidneys. We present the case of a 44-year-old female patient who underwent deceased donor kidney transplantation with negative complement-dependent cytotoxicity and flow cytometry crossmatch. Hours after graft reperfusion, given clinical evidence of primary nonfunction in the kidney, the patient underwent nephrectomy. Despite negative tests for blood type difference and crossmatch, and although the main artery and vein were well perfused, the kidney graft was never functional, and pathologic findings showed thrombotic microangiopathy and diffuse acute tubular necrosis. We conclude that further work on ideal criteria for identifying acceptable donor kidneys is needed.