Experience With Liver And Kidney Allografts From Non-Heart-Beating Donors

Abstract

Given the shortage of cadaveric organs, we began a study utilizing NHBD for OLTx and KTx. There were 24 NHBD between January 1989 and September 1993. These donors were divided into 2 groups: uncontrolled NHBD (G1) (n = 14) were patients whose organs were recovered following a period of CPR; and controlled NHBD (G2) (n = 10) were patients whose organs were procured after sustaining cardiopulmonary arrest (CA) following extubation in an operating room setting. Eight kidneys and 5 livers were discarded because of macroscopic or biopsy findings. In G1, 22/27 (81.5%) kidneys were transplanted; 14/22 (64%) developed ATN; 20/22 (95%) recipients were off dialysis at the time of discharge. With a mean follow-up of 32.7 +/- 21.1 months, sixteen (73%) kidneys are still functioning, with a mean serum creatinine of 1.7 +/- 0.6 mg/dl. The one-year actuarial patient and graft survivals are 95% and 86%. In G2, 17/20 (85%) kidneys were transplanted; 13/17 (76%) kidneys experienced ATN. All patients were off dialysis by the time of discharge. With a mean follow-up of 17.6 +/- 15.4 months, twelve (70%) kidneys are still functioning, with a mean serum creatinine of 2.5 +/- 2.1 mg/dl. The one-year actuarial patient and graft survivals are 94% and 82%, respectively. In G1, 6/10 (60%) livers were transplanted; 3/6 (50%) livers functioned, the other 3 patients required ReOLTx in the first week postoperatively because of PNF (n = 2) and inadequate portal flow (n = 1). Two functioning livers were lost due to HAT (n = 1) and CMV hepatitis (n = 1). In G2, 6/7 (85.7%) livers were transplanted. All the livers (100%) functioned. 2 patients required ReOLTx for HAT at 0.9 and 1.0 months. Both patients eventually died. One patient with a functioning liver died 2 months post OLTx. The remaining 3 patients are alive and well at 27 months of follow-up. This study shows that the procurement of kidneys from both uncontrolled and controlled NHBD leads to acceptable graft function despite a high incidence of ATN. The function of liver allografts is adequate in the controlled NHBD but suboptimal in the uncontrolled NHBD, with a high rate of PNF.

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

“…Prolonged warm ischemic time has also been associated with irreversible bile duct damage and poorer outcomes in NHBD grafts. [17][18][19] With respect to postoperative issues, there was no significant difference in the length of postoperative hospital stay, immunosuppressive regimen, number of acute or chronic cellular rejection episodes, or development of hepatic artery stenosis noted between patients with BCS and controls. However, the number of repeat hospital admissions after BCS diagnosis and the number of required biliary therapeutic procedures were significantly greater in BCS patients compared to controls.…”

“…The use of NHBD grafts has been previously shown to lead to a higher incidence of biliary complications. [19][20][21] A recent study from Johns Hopkins revealed the presence of biliary casts, proximal to ductal anastomotic strictures, in 35% of its NHBD liver transplants. 22 A possible reason that our current study did not show an increased incidence of BCS in NHBD grafts is the limited sample size.…”

Non heart beating organ donor: new experimental model in pigs

“…The most important issue regarding this modality is the gap between an insufficient pool of organ donors and the increasing number of potential recipients 1,3 .…”

“…Interestingly, there is not a standard technique available and the means of promoting the cardiac arrest may contribute to worsen organ preservation [2][3][4]6 . Thus, new experimental models of non heart beating donating will be useful to control research bias and allow further studies on organ transplantation.…”

Executive summary from the Intraoperative Advisory Council on Donation After Cardiac Death of the United Network for Organ Sharing: Practice guidelines

“…6 A change in practice occurred when laws granting the declaration of death according to neurologic criteria led to the preferential use of organs from brain-dead donors. 7 However, some institutions continued to recover DCD organs in addition to those of brain-dead donors.…”