Elsevier

Transplantation Proceedings

Volume 37, Issue 9, November 2005, Pages 3658-3660
Transplantation Proceedings

Organ donation
Clinical consideration
Renal Transplantation From Non–Heart-Beating Donors: A Single-Center 10-Year Experience

https://doi.org/10.1016/j.transproceed.2005.09.104Get rights and content

Abstract

Background

Reluctance to accept non–heart-beating donors (NHBD) as a source of kidneys, is due to medical, ethical, and logistical reasons. Evidence suggest that the short-term graft survival is similar to that of kidneys obtained from heart-beating donors (HBD). However, few studies, with long-term follow-up are available. We conducted a single-center study of kidneys obtained from NHBD, in a 14-year period.

Methods

We studied 100 patients transplanted with kidneys between 1989 and 2004, using NHBD, supported by heart compression and mechanical ventilation (n = 24), intravascular in situ cooling (n = 59), or cardiorespiratory resuscitation plus manual abdominal counterpulsation without cooling (n = 17), the last technique being used from 1998. The median follow-up was 51 ± 51 months (range, 1 to 170). The outcomes of these procedures were compared to those of 1025 transplantations of kidneys from HBD performed during the same period.

Results

The characteristics of the recipients did not differ significantly between the two groups. Kidneys from NHBD showed a significantly higher rate of delayed graft function (DGF; 84% vs 26%; (P < .001), furthermore, the primary nonfunction (PNF) incidence was significantly higher with NHBD vs HBD (16% vs 10%; P < .001). The incidence of acute rejection episodes (ARE) within 3 months and at 1 year did not differ between the groups of donors; however, more NHBD kidneys were lost from ARE. The short-term (3-month and 1 year) and long-term (5 and 10 years) renal function, determined by the serum creatinine levels, and patient and graft survival were not different for kidneys obtained from NHBD.

Conclusions

The incidences of PNF and DGF were significantly higher with NHBD, which produced poorer renal function at the time of hospital discharge. One-, 5-, and 10-year graft survivals and renal function did not differ between NHBD and HBD grafts. In our series, PNF was the main barrier to the use of NHBD.

Section snippets

Patients and methods

Between 1990 and 2004, we performed 100 renal transplants from 68 NHBD, both controlled and types I, II and IV, uncontrolled donors, classified according to the Maastricht categories. Age at death ranged from 17 to 70 years (mean 37 ± 14 years). We considered NHBD acceptable when warm ischemia time (WIT) was shorter than 120 minutes from the start of cardiac arrest to the start of perfusion. Only one patient of more than 65 years was accepted. Donor and recipient data are shown in Table 1.

NHBD

Renal Transplant From NHBD

Of 136 kidneys procured, 100 were transplanted. The remaining kidneys (26%) were discarded because of trauma, poor perfusion, atheromatosis, neoplasia, and other causes. Mean donor age was 37 ± 14 years (range, 17 to 70 y). WIT was 64 ± 52 minutes, and in situ cold perfusion time was 118 ± 79 minutes. Cold ischemia time was 23 ± 5 hours. The incidence of primary nonfunction (PNF) was 16%. However, the incidence of PNF was only 5.5%, for 17 kidneys transplanted from 1998, supported by mechanical

Discussion

The number of patients awaiting organs and the waiting time before transplantation have increased during the last decade. There is, therefore, a continuing challenge to maximize donor organ availability. In this framework, the retrieval of kidneys from NHBD has regained interest.5, 6, 7 NHB donation is still limited to a few transplantation centers.1, 7, 8, 9 In units in which an NHB program exists, a 7% to 50% increase in the number of renal transplants has been realized.1, 2, 4, 5, 6 From a

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