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Transplantation of kidneys from donors whose hearts have stopped beating
Y W Cho1, P I Terasaki, J M Cecka
1Department of Surgery, University of California at Los Angeles School of Medicine, USA.
Background:
Attempts have recently been made to expand the number of cadaveric kidneys available for transplantation by using kidneys from donors without heartbeats in addition to those from brain-dead donors with beating hearts. We studied the efficacy of transplanting kidneys from donors without heartbeats on the basis of aggregate results from the Kidney Transplant Registry of the United Network for Organ Sharing.
Methods:
We compared the early function and survival rates of 229 kidney grafts from donors without heartbeats with those of 8718 grafts from cadaveric donors with heartbeats. All transplantations were performed at 64 U.S. transplantation centers. Cox proportional-hazards analysis was used to evaluate 10 major risk factors for graft failure.
Results:
The survival rate at one year was 83 percent for kidney grafts from donors without heartbeats, as compared with 86 percent for grafts from donors with heartbeats (P=0.26). Among the kidneys from donors without heartbeats, the survival rate at one year was 89 percent for grafts from donors who had died of trauma, as compared with 78 percent for grafts from donors who had died of other causes (P=0.04). The survival rates were high for grafts from donors without heartbeats despite the poorer early function of these grafts; 48 percent of the recipients required dialysis within the first week after transplantation, as compared with 22 percent of the recipients of grafts from donors with heartbeats. The primary-failure rate for kidneys from donors without heartbeats was 4 percent, as compared with 1 percent for kidneys from donors with heartbeats.
Conclusions:
Transplantation of kidneys from donors whose hearts have stopped beating, especially those who have died of trauma, is often successful, and the use of kidneys from such donors could increase the overall supply of cadaveric kidney transplants.
Insights
Kidney transplants from donors without heartbeats show comparable survival rates to those with heartbeats. Kidneys from trauma donors without heartbeats had higher survival, increasing the cadaveric kidney supply.
Area of Science:
- Nephrology
- Transplantation Medicine
- Organ Donation
Background:
- Expanding cadaveric kidney availability is crucial for transplantation.
- Kidneys from donors without heartbeats (donation after circulatory death) are an underutilized resource.
- This study evaluates the efficacy of these kidneys compared to traditional donors.
Purpose of the Study:
- To assess the early function and survival rates of kidney grafts from donors without heartbeats.
- To compare these outcomes with grafts from donors with heartbeats.
- To identify factors influencing graft success in donation after circulatory death.
Main Methods:
- Analysis of aggregate data from the United Network for Organ Sharing Kidney Transplant Registry.
- Comparison of 229 kidney grafts from donors without heartbeats versus 8718 grafts from donors with heartbeats.
- Cox proportional-hazards analysis to identify risk factors for graft failure.
Main Results:
- One-year graft survival was 83% for donors without heartbeats vs. 86% for donors with heartbeats (P=0.26).
- Kidneys from trauma donors without heartbeats had a 1-year survival of 89%, compared to 78% for other causes (P=0.04).
- Despite poorer early function (48% vs. 22% requiring dialysis), overall survival was comparable, with a 4% primary failure rate for non-heartbeat donor kidneys versus 1% for heartbeat donor kidneys.
Conclusions:
- Kidney transplantation from donors without heartbeats, particularly those who died from trauma, is often successful.
- Utilizing these kidneys can significantly increase the availability of cadaveric kidney transplants.
- This approach offers a viable strategy to address organ shortages in kidney transplantation.