Victims of cardiac arrest occurring outside the hospital: a source of transplantable kidneys.
BACKGROUND
The use of non-heart-beating donors could help shorten the list of patients who are waiting for a kidney transplant. Several reports describe acceptable results of transplantations from non-heart-beating donors who had in-hospital cardiac arrest, but few reports describe results of transplantations from non-heart-beating donors who had cardiac arrest that occurred outside of the hospital (Maastricht type I and type II donors).


OBJECTIVE
To compare graft survival rates among patients receiving kidneys from heart-beating donors versus type I or type II non-heart-beating donors.


METHODS
Retrospective cohort study of transplantations performed from January 1989 to December 2004.


METHODS
Kidney transplant program of a teaching hospital in Madrid, Spain.


METHODS
320 patients who received a kidney transplant from non-heart-beating donors (273 type I donors and 47 type II donors) and 584 patients who received a kidney transplant from heart-beating donors divided into 2 groups according to donor age (age <60 years [n = 458] and age > or =60 years [n = 126]).


METHODS
The primary outcome measure was graft survival. The median follow-up time was 68 months (range, 9 to 198 months).


RESULTS
One- and 5-year graft survival rates were 90.7% and 85.5%, respectively, for transplants from heart-beating donors younger than 60 years of age; 79.8% and 73.3%, respectively, for transplants from heart-beating donors 60 years of age or older (P < 0.001); and 87.4% and 82.1%, respectively, for transplants from non-heart-beating donors (P = 0.22 [vs. those from heart-beating donors < 60 years of age] and P = 0.014 [vs. those from heart-beating donors >or = 60 years of age]). Graft survival did not differ between patients who received kidneys from heart-beating donors younger than 60 years of age and patients who received kidneys from non-heart-beating donors.


CONCLUSIONS
This single-site, observational study was retrospective, and immunosuppressive therapy regimens given to transplant recipients varied over time.


CONCLUSIONS
Outcomes of transplants from non-heart-beating donors and younger heart-beating donors are similar, and results for transplants from non-heart-beating donors improved compared with those from older heart-beating donors. On the basis of these results, the authors encourage other transplant units to adopt the use of type I and type II non-heart-beating donors.
Sánchez-Fructuoso
Ana I
AI
Hospital Clínico San Carlos, Universidad Complutense, and Servicio de Atención Municipal de Urgencias de Madrid, Madrid, Spain. sanchezfruct@telefonica.net
Marques
Maria
M
Prats
Dolores
D
Conesa
José
J
Calvo
Natividad
N
Pérez-Contín
M Jesús
MJ
Blazquez
Jesús
J
Fernández
Cristina
C
Corral
Ervigio
E
Del Río
Francisco
F
Núñez
Jose R
JR
Barrientos
Alberto
A
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D051799:Delayed Graft Function; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006323:Heart Arrest; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
D007166:Immunosuppressive Agents