title: Impact of Asystolic Donations in Kidney Transplant Activity From Cadaveric Donors in Andalusia.
abstract: BACKGROUND
  Kidneys from donors after brain death (DBD) cannot meet the demand for renal transplants in Andalusia.
  
  
  METHODS
  We analyzed the impact of using non-heart-beating donors (NHBD) in Andalusia from the start of this program to the present.
  
  
  RESULTS
  From 2010 to 2014, brain-death kidney donations remained at a standstill (1,635 in total) although NHBD increased from 2.4% to 16% annually, to 5% of the total (n = 164: 83 type II Maastricht [NHBD-T2] and 81 type III Maastricht [NHBD-T3]). The donors were more frequently men (T2 80.5% and T3 76.5% vs DBD 58.2%; P < .001). NHBD were younger (48.9 ± 10.8 y vs DBD 53.3 ± 16 y; P < .001); 11.6% of NHBD were >60 and 0% >70 years old, versus 39.4% and 15.2% of DBD, respectively; this is mostly explained by NHBD-T2 (48.9 ± 10.8 y vs DBD 53.3 ± 16 y). NHBD were used much less frequently than DBD in recipients over the age of 65 years or for retransplanted or hyperimmunized patients and never on priority recipients (children and combined transplant patients). Blood groups differed significantly among different donor types (A, O, B, AB): NHBD-T2 65.1%, 27.7%, 7.2%, and 0%, respectively; NHBD-T3 45.7%, 45.7%, 8.6%, and 0%; and DBD 46.5%, 39.4%, 10.2 %, and 3.9% (P = .01). The immediate output of the graft also differed in the proportion of primary nonfunction and delayed graft function: NHBD-T2 9.8% and 70.7%, respectively; NHBD-T3 5.0% and 65.0%; and DBD 5.9% and 28.7%.
  
  
  CONCLUSIONS
  The development of an NHBD program allows us to maintain and even increase transplants in our region. The impact on transplant access for O group recipients without priority will depend on the type of NHBD (low proportion of O group in NHBD-T2).
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U. Virgen del Rocío, Sevilla, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Gentil
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U. Virgen del Rocío, Sevilla, Spain. Electronic address: cgonzalezcorvillo@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Gonzalez-Corvillo
authors.affiliation: Coordinación Autonómica de Trasplantes, Andalucía, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Castro
authors.affiliation: Nephrology Department, Hospital Universitario Hospital Universitario Regional de Málaga, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ruiz-Esteban
authors.affiliation: Nephrology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gracia-Guindo
authors.affiliation: Nephrology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Garcia-Alvarez
authors.affiliation: Nephrology Department, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Agüera
authors.affiliation: Nephrology Department, Hospital Universitario Hospital U. Virgen del Rocío, Sevilla, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Ballesteros
authors.affiliation: Nephrology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Osuna
authors.affiliation: Coordinación Autonómica de Trasplantes, Andalucía, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000368:Aged; D003643:Death; D051799:Delayed Graft Function; D005260:Female; D006323:Heart Arrest; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D015397:Program Evaluation; D013030:Spain; D014019:Tissue Donors / Q000600:supply & distribution*; D020858:Tissue and Organ Harvesting / Q000706:statistics & numerical data; D019737:Transplants / Q000706:statistics & numerical data* / Q000600:supply & distribution