Tolerance dose of an implanted kidney

[Kroll2013]

What is the tolerance dose that is usually considered in practice for an implanted kidney?

Thx

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[seper]

nobody knows; please write it up as a case report if pt survives > 3 m

 

[Palex80]

Probably roughly the same as for a non-implanted kidney, as long as it seems that the implanted kidney does not have an impaired function, which you can check with numerous tests.

 

[seper]

disagree... it's probably sublinically impaired from the moment donor blood supply is cut off. Also, no literature that I'm aware of adjusting dose limits to kidneys based on GFR.

 

[Palex80]

disagree... it's probably sublinically impaired from the moment donor blood supply is cut off. Also, no literature that I'm aware of adjusting dose limits to kidneys based on GFR.

So what would you do?

1. I actually talked to a friend of mine in nephrology. He told me that patients with implanted kidneys usually have the same functional renal status like patients with only one (own) kidney, as long as the implanted kidney has not suffered any damage due to medication (cyclosporin) or immunologic processes.

2. You want to tell me, that in patients with impaired renal function you don't use "tighter" kidney constraints than in patients with perfectly normal kidney function?
I often adjust plans to spare kidneys more, when I see that the patients have an abnormal GFR.
It happens quite often, for example when you are treating lung cancer patients, who have gone through platinum based therapy and require irradiation for vertebral metastatic disease close to the kidneys.

 

[napoleondynamite]

FWIW, RTOG uses a D15 <18Gy for a single kidney (see RTOG 0848 dose constraints)