Renal transplantations performed using non-heart-beating organ donors: going back to the future?
BACKGROUND
As more expanded-criteria organ donors are used to bridge the widening gap between organ supply and demand, non-heart-beating (NHB) donors will become increasingly important. The purpose of this study was to analyze renal transplant outcomes using this source of cadaveric (CAD) organs and compare the results with heart-beating organ sources.


METHODS
Data from 98,698 adult CAD renal transplant recipients and 34,531 living donor renal transplant recipients registered in the U. S. Renal Data System database between January 1993 and June 2000 were analyzed. Kaplan-Meier survival curves were used to compare graft and patient survival rates between NHB, CAD, and living donor transplant recipients. Cox proportional hazards models were used to identify risk factors for NHB donor recipients, while adjusting for potential confounding variables.


RESULTS
Recipients of NHB donor organs experienced nearly twice the incidence of delayed graft function (DGF) compared with heart-beating donors (42.4% vs. 23.3%, respectively). NHB donor transplants experienced comparable allograft survival when compared with CAD transplants at 6 years (73.2% vs. 72.5%, respectively; P=NS); patient survival was greater at 6 years for NHB compared with CAD renal transplant recipients (80.9% vs. 77.8%, respectively; P=NS). Significant factors for allograft loss for NHB donor organ recipients included the following: organ used for repeat transplants; DGF; donor age older than 35 years; and head trauma as a cause of initial injury (relative risk 2.74, 1.90, 1.78, and 1.41, respectively).


CONCLUSIONS
Although exhibiting elevated DGF rates, allograft and patient survival rates of transplants from NHB donor sources are equivalent to those from conventional CAD sources. Donor age, recipient transplant number, female recipient, mechanism of injury, and DGF were the most pertinent variables leading to poor outcomes.
Rudich
Steven M
SM
Division of Transplant Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
Kaplan
Bruce
B
Magee
John C
JC
Arenas
Juan D
JD
Punch
Jeffrey D
JD
Kayler
Liise K
LK
Merion
Robert M
RM
Meier-Kriesche
Herwig-Ulf
HU
D000328:Adult; D017677:Age Distribution; D005260:Female; D006085:Graft Survival; D006323:Heart Arrest; D006801:Humans; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D014481:United States