title: A good alternative to reduce the kidney shortage: kidneys from nonheartbeating donors.
abstract: BACKGROUND
  Because of the shortage of kidneys available for transplantation, we began in 1985 to harvest kidneys from non-heartbeating (NHB) donors.
  
  
  METHODS
  We compared the results of a group of 66 kidney recipients from NHB donors (NHB group) with 122 kidney recipients from heartbeating donors (HB group). We analyzed, in the NHB group, the influence of ischemia times in graft survival and we tested the best cut-offs by receiver operating characteristic curves. We also studied, using a univariate and multivariate Cox hazard model, the capacity of different variables to predict graft loss.
  
  
  RESULTS
  Patient and graft survival were similar in both groups during the follow-up. The percentage of delayed graft function was the only significant difference between both groups (NHB group 62% vs. HB group 32%; P=0.0001). Delayed graft function, in the NHB group, is influenced by the warm ischemia time, which is directly related to the number of days to achieve a serum creatinine<300 mmol/L (P=0.0001). The best cut-off times in this group were 45 min for warm ischemia time and 22 hr for cold ischemia time. Recipients have a greater likelihood of losing the graft beyond those limits (P=0.017, relative risk: 7.3). The incidence of acute rejection was similar in both groups, and it was the only predictor factor of graft loss in the complete series of patients (P=0.0001), in the NHB group (P=0.007), and in the HB group (P=0.02).
  
  
  CONCLUSIONS
  Reducing the incidence of acute rejection and shortening ischemia time are conditions needed to guarantee a long graft survival of kidneys from NHB donors.
authors.affiliation: Department of Transplant Coordination, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: González-Segura
authors.forename: A M
authors.initials: AM
authors.lastname: Castelao
authors.forename: J
authors.initials: J
authors.lastname: Torras
authors.forename: F
authors.initials: F
authors.lastname: Moreso
authors.forename: L
authors.initials: L
authors.lastname: Riera
authors.forename: M A
authors.initials: MA
authors.lastname: López-Costea
authors.forename: M
authors.initials: M
authors.lastname: Pascual
authors.forename: J M
authors.initials: JM
authors.lastname: Grinyó
authors.forename: J
authors.initials: J
authors.lastname: Alsina
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome