2006 Papers - Inouye


Methamphetamine use history in deceased kidney donors impairs renal function in recipients one-year post transplant.

David S. Inouye, MD, PhD, University of Hawaii Surgical Residency Program
Faculty Supervision: Linda L. Wong, MD, FACS

Hypothesis: Methamphetamine (MA) has cumulative and deleterious effects on multiple organ systems. A history of MA use in kidney donors may adversely affect long-term graft function in recipients.

Design: Retrospective case-controlled study of renal transplant patients from September 2001 to March 2004.

Setting: Community-based transplant referral center.

Patients: Records of deceased donor kidney transplants recipients were reviewed. Recipients with transplants from deceased standard donors having documented MA use (n=24) were compared to a convenience sample of recipients with transplants from deceased donors without MA use history (n=22).

Main Outcome Measure: Mean serum creatinine at 1 year (Cr³⁶⁵) post-transplant. Mean serum creatinine at 7 days (Cr⁷) used as a baseline reference.

Results: No difference was detected in Cr⁷ between the two groups (Cr⁷=2.5 for grafts from MA donors versus Cr⁷ =2.2 in controls, p=0.69). However, recipients with grafts from MA donors had higher Cr³⁶⁵ compared to control recipients (Cr³⁶⁵ =2.4 versus 1.4, p=0.04). MA donors averaged 37 years-old (17 to 48) and had a mean procurement Cr of 0.9 (SD 0.22). Of kidneys harvested from MA donors, the cause of death was cerebrovascular accident in 14 (58%). Eight kidneys were from donors with current or prior hypertension. All MA donors fulfilled UNOS standard donor criteria.

Conclusions: Kidneys from donors with a history of MA use showed impaired graft function 1-year post transplant compared to controls. This impairment is not detectable immediately post-transplant or by UNOS donor criteria. In assessing donor status, a history of MA use appears linked toward marginal donor status.