pISSN 2671-8790 eISSN 2671-8804


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Korean J Transplant 2022; 36(3): 226-230

Published online September 30, 2022


© The Korean Society for Transplantation

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

Sang Oh Yun1,* , Min Jung Kim2,* , Kyo Won Lee1 , Jae Berm Park1

1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Surgery, Seoul Medical Center, Seoul, Korea

Correspondence to: Kyo Won Lee
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnam-gu, Seoul 06351, Korea
Tel: +82-2-3410-0842
Fax: +82-2-3410-0400
E-mail: kw1980.lee@gmail.com
*These authors contributed equally to this work.

Received: April 19, 2022; Revised: May 12, 2022; Accepted: May 16, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

Keywords: Kidney transplantation, Primary non-function, Acceptable donor kidney, Case report

  • This is a case report of immediate graftectomy due to primary non-function.

  • What we want to emphasize in our case is that early graft failure can occur even when active preoperative evaluations are performed on both donors and recipients.

  • The purpose is not to reduce the use of kidneys belonging to expanded criteria donor (ECD), but to find an ideal kidney for transplantation among kidneys belonging to ECD through various methods.