Outcomes After Kidney Transplantation from Cyanide-Poisoned Donors

초록

Purpose: The growing shortage of organ donors has led to increased utilization of marginal donors, including those who become brain dead due to poisoning. However, the impact of blood toxin levels and antidotal treatments on organ suitability for transplantation remains unclear. This report examines successful kidney transplantations from two cyanide-poisoned donors treated with hydroxocobalamin. Methods: In Korea, there have been two cases of cyanide-poisoned donors to date, and the outcomes of the recipients were analyzed. Results: The fi rst case involved a 54-year-old male who ingested potassium cyanide. Blood cyanide levels, measured by the National Forensic Service, were 1.5 mg/L on the day of ingestion and 0.1 mg/L fi ve days later. Duringhospitalization, renal function was stable. On the seventh day, the patient was declared brain dead, and organ donation was carried out. A 27-year-old male recipient with negative PRA I and II received the kidney, which weighed 235 g and had a cold ischemic time of 65 minutes. No delayed graft function (DGF) or complications occurred, and blood creatinine levels remained stable after transplantation. The second case involved a 67-year-old male who was transported after cyanide ingestion. Due to the unavailability of toxicological, the decision to proceed with the transplantation was made based on existing data regarding the half-life of cyanide. The patient received hydroxocobalamin treatment, and despite the presence of cherry-colored urine, kidney function remained stable. The procurement was conducted after the reported maximum half-life of 66 hours and zero-time biopsy showed no renal damage. One kidney was transplanted into a 60-year-old female and the other into a 50-year-old male. Both recipients showed stable renal function without DGF or complications, with follow-up creatinine levels within normal ranges. Conclusions: These cases demonstrate that successful kidney transplantation from cyanide-poisoned donors is possible even in the absence of cyanide blood testing, with appropriate antidote therapy, careful monitoring of renal function, and timing of surgery to account for the half-life of cyanide.