Factors influencing short- and long-term survival of kidneys transplanted from non-heart-beating donors

Alvarez, Julissa; Barrio, Roberto; Martin, Martha; Rodriguez, G.; Blesa, A.L.; Ramos, J M; Nieto, M.; Martin-Santos, F.

doi:10.1016/s0041-1345(97)00992-5

Cited by 7 publications

(5 citation statements)

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“…DGF occurs more frequently in NHBD (50–100%)92,94 than in HBD (20–60%) kidneys57,91,100. This increased DGF rate in NHBD kidney is likely to be a consequence of acute tubular necrosis (ATN) secondary to warm ischaemic damage.…”

Section: Discussionmentioning

confidence: 99%

Non Heart-Beating Donors in England

Chaib

2008

Clinics

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Chaib E. Non heart-beating-donors in England. Clinics. 2008;63(1):121-34. When transplantation started all organs were retrieved from patients immediately after cardio-respiratory arrest, i.e. from nonheart-beating donors. After the recognition that death resulted from irreversible damage to the brainstem, organ retrieval rapidly switched to patients certified dead after brainstem testing. These heart-beating-donors have become the principal source of organs for transplantation for the last 30 years. The number of heart-beating-donors are declining and this is likely to continue, therefore cadaveric organs from non-heart-beating donor offers a large potential of resources for organ transplantation. The aim of this study is to examine clinical outcomes of non-heart-beating donors in the past 10 years in the UK as an way of decreasing pressure in the huge waiting list for organs transplantation. KEYWORDS:Transplantation. Liver. Kidney. Donors.The imbalance between supply of organs for transplantation and demand for them is widening all over the world. In the United Kingdom (UK) the figures are not different, by the end of December 2004 there were over 6000 people on the active waiting list for organ transplantation. Recent data suggest that over 400 of these people will die each year before a new organ becomes available.

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Section: Discussionmentioning

confidence: 99%

Non Heart-Beating Donors in England

Chaib

2008

Clinics

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“…Taken together, the absence of phenomena associated with explosive brain‐stem death may protect the NHBD graft from the early inflammatory and immunological events associated with the ischaemia–reperfusion syndrome (28), as the sudden cardiac standstill does not allow for circulation of these factors. These theoretical effects have yet to be demonstrated in human kidneys, although Alvarez et al (33) showed that kidneys from ITU‐based NHBDs had poorer short‐ and long‐term function, and were associated with a greater rate of PNF than NHBD kidneys procured from the emergency department, and this was strongly associated with periods of hypotension prior to retrieval. Thus, protracted periods of physiological instability result in poorer post‐transplant outcome in controlled NHBDs, and this may apply to HBD kidneys from the ITU setting.…”

Section: Discussionmentioning

confidence: 99%

Non-Heart Beating Donor Kidneys with Delayed Graft Function Have Superior Graft Survival Compared with Conventional Heart-Beating Donor Kidneys That Develop Delayed Graft Function

Brook

White

Waller

et al. 2003

American Journal of Transplantation

111

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Delayed graft function may have an association with reduced graft survival, and nonheart-beating donor (NHBD) kidneys have higher rates of delayed graft function (DGF) than heart-beating donor (HBD) kidneys. This study compared outcome of renal transplants from HBDs who developed DGF, with NHBDs who developed DGF.All recipients of HBD and NHBD kidneys who developed DGF were identified during a 10-year period. All patients with graft primary nonfunction were excluded from analysis.Four hundred and fifty-six functioning transplants were performed. Delayed graft function occurred in 69 (17%) HBD and 55 (93%) NHBD kidneys. The grafts developing DGF were well matched for donor and recipient age. The rate of acute rejection was similar; [n = 16/69 (23%) HBD vs. n = 13/55 (24%) NHBD]. Cold ischaemia was 21 h in the HBD group and 17 h in NHBD group (p > 0.05). Serum creatinine was similar for both groups at 1.3 and 6 years (p > 0.05 for all time points). Graft survival in the NHBD recipients with DGF was significantly better at 3 years (84%) compared with recipients of a HBD renal transplant that developed DGF (73%) (p < 0.05), and at 6 years (62% survival for HBDs and 84% survival for NHBDs).This study shows that graft survival was better for NHBD kidneys up to 6 years after transplantation.

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“…Delayed graft function occurs more frequently in NHBD (50–100%) (30, 31) than in HBD (20–60%) kidneys (17, 32, 33). This increased DGF rate in NHBD kidneys is likely to be a consequence of acute tubular necrosis secondary to warm ischaemic damage.…”

Section: Delayed Graft Functionmentioning

confidence: 99%

A report on the activity and clinical outcomes of renal non‐heart beating donor transplantation in the United Kingdom

Brook¹,

Waller²,

Richardson³

et al. 2004

Clinical Transplantation

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The use of kidneys from non-heart beating donors (NHBDs) presents a paradox; whilst they provide more organs for transplantation, there is an increased risk of poor graft outcome, particularly in the short term. This study has highlighted the difference in early graft function and late graft survival between NHBD kidneys with short (controlled) and long (uncontrolled) warm ischaemic times. Whilst it would seem that it is preferable to use controlled donors only, their numbers are small. By employing a rational approach to the use of each of these types of kidney, such as structured viability assessment and risk analysis, it may be that the results of uncontrolled NHBD can be improved.

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Factors influencing short- and long-term survival of kidneys transplanted from non-heart-beating donors

Cited by 7 publications

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Non Heart-Beating Donors in England

Non Heart-Beating Donors in England

Non-Heart Beating Donor Kidneys with Delayed Graft Function Have Superior Graft Survival Compared with Conventional Heart-Beating Donor Kidneys That Develop Delayed Graft Function

A report on the activity and clinical outcomes of renal non‐heart beating donor transplantation in the United Kingdom

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