Kidney procurement from non-heartbeating donors: transplantation results

To overcome the shortage of kidneys (kdn's) available for transplantation we reactivated kdn procurement from non-heartbeating donors (NON-HBD). In this study, we reviewed our results with 34 kdn's from NON-HBD, transplanted between 1985 and 1991, and compared these with 34 control kdn's procured from heartbeating donors (HBD) matched for age, sex, primary graft or retransplant and transplant year. There was no difference in cold ischemia time, preservation solutions used, duration and type of preoperative dialysis, number of HLA mismatches and serum antibody levels between the two groups. The only significant findings were a lower diuresis in the last hour in the donors in the NON-HBD group, and a significantly higher serum creatinine level compared to the HBD group. The 1-year patient and graft survival rates were 89.4% and 84.9% for the HBD group, and 78% and 76.1% for the NON-HBD group respectively. There was need for dialysis support in the first posttransplant week in 10 out of 34 (29%) recipients in the HBD and 17 out of 34 (50%) recipients in the NON-HBD group. Primary non-function was observed in 1 of 34 (3%) recipients in the HBD group versus 3 of 34 (9%) in the NON-HBD group. None of the differences were statistically significant. There was also no difference in average serum creatinine levels at days 1, 3, and 7, at 1 month and at 1 year between the HBD and NON-HBD groups. In the NON-HBD group 6 of 34 kdn's (18%), 5 of which were retransplants, showed vascular rejection, 5 of them associated with haemolytic uremic syndrome (thrombotic microangiopathy); 2 of these 6 kdn's recovered, and 4 failed (2 with primary non-function). This important observation needs to be investigated further. The results is this study showed, however, that good short- and long-term results can be achieved with kdn's from NON-HBD. We concluded that organ procurement from NON-HBD is an adequate approach to an important cadaver donor source that in general is not effeciently used, but could significantly increase the number of kdn grafts in most transplant programs.