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Simultaneous pancreas-kidney (SPK) transplantation from controlled non-heart-beating donors (NHBDs)
A M D'Alessandro1, J S Odorico, S J Knechtle
1Division of Organ Transplantation, University of Wisconsin Medical School, Madison 53792, USA. tony@tx.surgery.wisc.edu
Cell Transplantation
|February 24, 2001
Summary
Simultaneous pancreas-kidney transplants from controlled non-heart-beating donors (NHBDs) show comparable patient and graft survival to heart-beating donors (HBDs). NHBDs may increase transplant availability despite higher rates of enteric conversions and acute tubular necrosis.
Area of Science:
- Transplantation Medicine
- Organ Donation
- Nephrology
Background:
- Simultaneous pancreas-kidney transplantation (SPK) is a crucial treatment for end-stage renal and pancreatic disease.
- The utilization of organs from non-heart-beating donors (NHBDs) is being explored to expand the donor pool.
Purpose of the Study:
- To evaluate the outcomes of SPK from controlled NHBDs compared to heart-beating donors (HBDs).
- To assess the viability of using controlled NHBDs for SPK to increase transplant availability.
Main Methods:
- A retrospective analysis of 18 SPKs from controlled NHBDs and 339 SPKs from HBDs performed between January 1993 and June 1999.
- Comparison of donor characteristics, post-transplant pancreatic function, enteric conversions, acute tubular necrosis (ATN), discharge serum creatinine, rejection rates, patient survival, and allograft survival.
Main Results:
- NHBDs had a longer warm ischemic time (14.8 min) but no difference in donor characteristics otherwise.
- Higher rates of enteric conversions (32% vs. 13%) and ATN requiring hemodialysis (22.2% vs. 4.1%) were observed in NHBD recipients.
- Lower rejection-free rates (33.3% vs. 50.1%) approached significance for NHBDs, but patient and allograft survival rates were comparable between NHBD and HBD groups.
Conclusions:
- SPK transplantation from controlled NHBDs is a viable option for increasing organ availability.
- Despite increased risks of enteric conversions and ATN, NHBD SPK offers comparable long-term patient and graft survival to HBD SPK.