Results of transplantation with kidneys from non-heart-beating donors

Full text

Introduction

During the last twenty years, thirty kidneys from non-heart-beating donors (NHBD) were used for transplantation in our hospital. We examined the results of these transplantations.

Methods

For every recipient from a NHBD kidney, we selected two recipients who received a kidney from a heart-beating cadaveric donor, as a control group (60). The control group was selected by matching the following items: first or retransplantation, HLA-AB or HLA-DR compatibility, cold ischaemia time, immunosuppressive medication and date of transplantation.

Results

According to "the Maastricht categories" classification from the NHBD resulted in: 1) death on arrival (n=3); 2) unsuccessful resuscitation (n=2); 3) awaiting cardiac arrest (n=14); 4) cardiac arrest while brain dead (n=11). The mean duration of follow-up was 4.5 years. Graft survival rates at 1 and 5 years after transplantation were 87% and 57% respectively in the NHBD group and 85% and 72% in the control group (NS). The incidence of acute tubular necrosis(ATN) was 53% in the NHBD group and 30% in the control group (P<0.05). With regard to graft function there was no difference between both groups. In transplantations with NHBD-kidneys, warm ischaemia time (WIT) shorter than 30 min was accompanied by a better graft survival than WIT longer than 30 min (5 year graft survival 81% versus 33%, P<0.05). The incidence of ATN in kidneys with WIT shorter than 30 min was 40% versus 67% in kidneys with WIT of more than 30 min (NS).

Conclusion

Our results confirm that the use of kidneys from NHBD is a valuable contribution to a kidney transplantation program. A short WIT clearly leads to better results.