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CASE REPORT
Successful Kidney Transplant From a Brain Stem-Dead Donor Due To Lethal Methanol Poisoning

Kidney replacement is the best treatment modality for chronic renal failure; however, the greatest obstacle for transplant is the scarce number of donor organs. In the United States and Europe, less than 1% of organs for transplant are provided from patients with lethal poisoning. In this paper, we present a successful kidney transplant from a donor with methanol poisoning. A 38-year-old-man who had methanol poisoning developed brain stem death after unsuccessful treatment and was a candidate to be a kidney donor for transplant to a 27-year-old male patient with chronic renal failure. Three weeks after kidney transplant, the recipient was discharged with good kidney function. We suggest that it may be possible to consider lethal methanol poisoning for kidney donation.


Key words : Chronic renal failure, Extended criteria donor, Renal replacement, Renal transplant

Introduction

A main issue for kidney transplant, which is the best treatment for chronic renal failure, is organ shortage. In the United States and Europe, less than 1% of organs for transplant are provided from donors after poisoning brain death.1 Here, we describe a 38-year-old man with methanol poisoning who, after 7 days of unsuccessful treatment for methanol poising and who lapsed into a deep coma, was referred to our center with diagnosis of brain death. A kidney was retrieved from the donor.

Case Report

A 38-year-old man, following ingestion of methanol alcohol, presented with blurred vison to a poisoning center. After dialysis and treatment, the patient developed deep coma and was formally diagnosed with brain death. He was referred to our organ transplant department. Kidney function (acute tubular necrosis) was stabilized, and a retrieved kidney was grafted to a 27-year-old man with chronic renal failure. Due to proliferative glomerulonephritis, he was treated with 3 medicines, which included tacrolimus, mycophenolic acid, and prednisolone. After 3 weeks, the transplant recipient was discharged with creatinine level of 1.5 mg/dL.

Discussion

Organ shortages remain a problem in kidney transplant. In the United States and Europe, brain death donors due to poisoning provide less than 1% of organs available for transplant.1 There have been rare cases of kidney, heart, and pancreas donations from brain-dead donors with methanol, cyanide, and carbon dioxide poisoning.2

Kidney transplant from donors with methanol poisoning has been reported in the United States, Spain, and Belgium.3-7 After absorption in the gastrointestinal tract, methanol is changed to formate in the liver, which is responsible for the toxicity of methanol.8 The first case of a kidney donor with methanol poisoning in a recipient with long-term kidney function was reported by Friedlaender and associates.9 The first renal and pancreas transplant in a donor with brain death after methanol ingestion was reported by Chari and colleagues.10 The recipients did not develop any signs or symptoms of methanol poising after transplant.11

Conclusions

Brain dead donors due to poisoning could be another source of organ donations.2 We suggest that organ transplant centers consider brain dead patients with poisoning for possible organ donation. Donors with brain death after methanol poisoning should especially be considered for kidney donations.


References:

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DOI : 10.6002/ect.2019.0238


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From the Organ Transplantation Center, Imam Reza Hospital, Tabriz Medical Science University, Tabriz, Iran
Acknowledgements: The authors have no sources of funding for this study and have no conflicts of interest to declare.
Corresponding author: Afshar Zomorrodi, Organ Transplant Department, Imam Reza Hospital, Tabriz Medical Science University, Tabriz, Iran
Phone: +98 9141147229
E-mail: zomorrodi2017@gmail.com