A comparison of the results of renal transplantation from non-heart-beating, conventional cadaveric, and living donors.
BACKGROUND
In an attempt to address the shortage of conventional kidney donors, a non-heart-beating donor (NHBD) organ retrieval program has been established. We compared the results of kidney transplants from NHBDs (N = 77) with those from heart-beating cadaveric (HBD; N = 224) and living donors (LD; N = 49), performed in the same eight-year period.


METHODS
Patients dying after failed attempts at resuscitation in the accident department or after intracerebral hemorrhage/anoxia were considered as potential NHBDs. After death, in situ kidney perfusion and cooling were achieved using an intra-aortic catheter inserted via a femoral artery cut down. Kidney retrieval and transplant operations were performed using standard techniques.


RESULTS
The median (range) warm ischemic time for NHBD kidneys was 25 minutes (5 to 53 min). The initial function rates for NHBD, HBD, and LD transplants were 6.5, 76.3, and 93%, respectively. Primary nonfunction occurred in 5 of 75 evaluable NHBD transplants (7%) compared with only 6 out of 224 (2.7%) HBD and 1 out of 49 (2%) LD transplants (P = NS). Eighty-four percent of NHBD kidney recipients required postoperative dialysis for a median of 19 days. The mean (SD) serum creatinine at 12 months was 179 (73) micromol/L in NHBD kidneys compared with 152 (57) micromol/L for HBD kidneys and 138 (44) micromol/L for LD kidneys. The actuarial five-year graft survival rates for NHBD, HBD, and LD transplants were 79, 75, and 78%, respectively. During the period under study, NHBD organs accounted for 22% of the total renal transplant program.


CONCLUSIONS
Despite being associated with poor initial graft function, the long-term allograft survival of NHBD kidneys does not differ significantly from the results of HBD and LD transplants.
Nicholson
M L
ML
Departments of Surgery and Nephrology, University of Leicester, Leicester General Hospital, Leicester, England,United Kingdom.
Metcalfe
M S
MS
White
S A
SA
Waller
J R
JR
Doughman
T M
TM
Horsburgh
T
T
Feehally
J
J
Carr
S J
SJ
Veitch
P S
PS
D000328:Adult; D001926:Brain Death; D002102:Cadaver; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D019520:Living Donors; D008875:Middle Aged; D009200:Myocardial Contraction; D012307:Risk Factors; D009927:Tissue and Organ Procurement / Q000379:methods; D016896:Treatment Outcome