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Updated: Mar 25, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
A case of kidney transplantation using donation after circulatory death with renal calculi
Baoshan Gao1, Kun Zhang1, Chunjie Guo2
1Department of Urology/Transplant Center, First Hospital of Jilin University Changchun, China.
Insights
Donation after circulatory death (DCD) kidneys with stones can be salvaged. Ex vivo bench surgery and perfusion preservation successfully prepared a borderline DCD kidney for transplantation, demonstrating a promising approach for increasing organ availability.
Area of Science:
- Nephrology
- Transplantation Surgery
- Organ Preservation
Background:
- Donation after circulatory death (DCD) is a significant source of donor kidneys.
- DCD donor kidneys often have lower quality due to ischemia and perfusion issues.
- Kidneys with pre-existing conditions like stones are frequently discarded.
Purpose of the Study:
- To describe a method for salvaging a Donation after Circulatory Death (DCD) donor kidney with multiple stones.
- To evaluate the feasibility of ex vivo bench surgery combined with advanced preservation techniques for borderline DCD kidneys.
Main Methods:
- A modified ex vivo pyelolithotomy and ureteroscopy were performed on the donor kidney to remove stones.
- The kidney allograft underwent hypothermic oxygenation and perfusion preservation.
- The prepared kidney was transplanted into a recipient.
Main Results:
- The ex vivo bench surgery successfully rendered the donor kidney stone-free.
- The recipient experienced no complications during the initial two-month post-transplant follow-up.
- This approach successfully utilized a previously borderline DCD donor kidney.
Conclusions:
- Ex vivo bench surgery and hypothermic perfusion preservation can salvage Donation after Circulatory Death (DCD) donor kidneys with stones.
- This combined technique offers a promising strategy to expand the donor pool by utilizing borderline organs.
- Successful transplantation of a stone-containing DCD kidney highlights the potential to overcome traditional discard criteria.
Abstract:
Donation after circulatory death (DCD) supplies a big percentage of the organ source pool. Compared to living-related donations, donor kidneys from DCD are commonly with lower quality since they inevitably suffer from hypoxia, hypotension, and inadequate organ perfusion during the progression to circulatory arrest. The current case presents a 44-year-old male donor with wide range subarachnoid hemorrhage and multiple skull fracture from a car accident. Multiple stones were detected in his right kidney. We performed a modified ex vivo pyelolithotomy and ureteroscopy on the bench to render a stone-free allograft. We also improved the donor kidney with hypothermic/perfusion preservation machine before renal transplantation. The recipient showed no complications during the first two-month post-operational follow-up. Such a donor kidney with stones may probably be discarded by conventional perspective. Yet, the combination of the ex vivo bench-surgery technique and hypothermic oxygenation/perfusion makes it a qualified donor kidney. Thus we have demonstrated a promising way of saving borderline qualified DCD donor kidneys.
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