The maintenance strategy of brain injury donors with diabetes insipidus and its clinical efficacy on kidney transplantation

Objective To summarize the maintenance strategy of brain injury donors with diabetes insipidus and evaluate its clinical efficacy after kidney transplantation. Methods The clinical data of donors with diabetes insipidus and corresponding kidney transplant recipients who got transplantion during January 2016 and September 2018 in the Department of Organ Transplantation, Renmin Hospital of Wuhan University were retrospectively analyzed. The maintenance strategy of diabetes insipidus, anastomotic methods and prognosis conditions of recipients were summarized. The paired-t test was used to compare the blood pressure, hourly urine volume, heart rate, blood sodium level, urine specific gravity, body temperature, plasma osmotic pressure and serum creatinine before and after treatment in donors with diabetes insipidus. P<0.05 was considered statistically significant. Results After systemic anti-diabetes insipidus treatment, blood pressure, hourly urine volume, heart rate, blood sodium level, urine specific gravity, body temperature, plasma osmotic pressure and serum creatinine were significantly improved in donors with diabetes insipidus. The differences was statistically significant (P all <0.05). When the kidney was obtained, it was well perfused with good color and texture and without thrombosis or ecchymoses. After the repairing, the reperfusion was performed by blood transfusion set, and the perfusion was good. Of the 24 recipients, the renal function of 19 recipients recovered immediately (serum creatinine <133 μmol/L) and the recover time was (10±3) days after transplantation. Five recipients developed delayed graft function (DGF), the duration of dialysis replacement therapy is (9±3) days, and the recover time was (23±4) days after transplantation. One recipient with DGF underwent secondary surgery because of transplant kidney hemorrhage, and the renal function recovered on the 19th day after transplantation. The average serum creatinine of all recipients was (105±43) μmol/L 3 months after transplantation. Two recipients experienced acute rejection during the perioperative period and were reversed after application of rabbit anti-human thymocyte globulin (rATG). As of December 2018, there were 7 recipients developed post-transplant complications, includeing 4 cases of acute rejection, 2 of them were reversed by methylprednisolone therapy, and the other 2 cases were reversed by methylprednisolone+ rATG therapy. Two recipients developed lung infections and recovered after anti-infective therapy. One recipient developed renal artery stenosis 3 months after operation and recovered after interventional therapy. Conclusions Diabetes insipidus is a common clinical syndrome of donors with craniocerebral injury. The occurrence of diabetes insipidus may affect the quality of donor kidney. Comprehensive monitoring and active treatment of diabetes insipidus may contribute to the maintenance of renal function and promote early recovery of transplanted kidney. Key words: Brain injury; Diabetes insipidus; Organ donation; Kidney transplantation; Donor maintenance