2065 A COMPARISON OF THE OUTCOMES OF RENAL TRANSPLANTATION FROM HEART-BEATING CADAVERIC DONORS, AND NON-HEART-BEATING WHO PRESENT IRREVERSIBLE CARDIAC ARREST OCCURRING OUTSIDE THE HOSPITAL

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery1 Apr 20112065 A COMPARISON OF THE OUTCOMES OF RENAL TRANSPLANTATION FROM HEART-BEATING CADAVERIC DONORS, AND NON-HEART-BEATING WHO PRESENT IRREVERSIBLE CARDIAC ARREST OCCURRING OUTSIDE THE HOSPITAL Felipe Villacampa, José Medina-Polo, Federico de la Rosa, Manuel Pamplona, Alfredo Rodríguez, Juan Passas, José Manuel Duarte, Eduardo Gutiérrez, Teresa Dipalma, and Rafael Díaz Felipe VillacampaFelipe Villacampa Madrid, Spain More articles by this author , José Medina-PoloJosé Medina-Polo Madrid, Spain More articles by this author , Federico de la RosaFederico de la Rosa Madrid, Spain More articles by this author , Manuel PamplonaManuel Pamplona Madrid, Spain More articles by this author , Alfredo RodríguezAlfredo Rodríguez Madrid, Spain More articles by this author , Juan PassasJuan Passas Madrid, Spain More articles by this author , José Manuel DuarteJosé Manuel Duarte Madrid, Spain More articles by this author , Eduardo GutiérrezEduardo Gutiérrez Madrid, Spain More articles by this author , Teresa DipalmaTeresa Dipalma Madrid, Spain More articles by this author , and Rafael DíazRafael Díaz Madrid, Spain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2338AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Non-heart-beating donors who present irreversible cardiac arrest occurring outside the hospital are a valuable source of kidneys for renal transplantation and they could help shorten the list of patients who are waiting for a kidney transplant. However, the significant degree of warm ischemic injury suffered by non-heart-beating kidneys leads to a greater incidence of primary non-function and delayed graft function than those from brainstem dead heart-beating donors. Our purpose was to compare the outcomes of kidney transplants from non-heart-beating donors (Maastricht donors type I and II) and heart-beating cadaveric donors. METHODS We retrospectively compared the results of kidney transplants from non-heart-beating donors performed in our institution from July 2005 to December 2009 with a control group of heart-beating cadaveric donors with similar donor and recipient age. The non-heart-beating donors were mostly of the Maastricht I category. RESULTS Results are shown in the table. Non-heart-beating donors (n = 100) Heart-beating cadaveric donors (n = 100) p value Donors age (years) 38.5±10 39.2±18 ns Recipients age (years) 46±11 45±14 ns Donor serum creatinine (mg/dl) 1.1±0.3 0.9±0.3 ns Delayed onset of Tacrolimus with Timoglobulin induction (%) 85% 8% 0.001 Primary non-function (%) 8% 4% ns Delayed graft function (%) 85% 39% 0.001 Acute rejection incidence (%) 6% 17% 0.01 Graft survival (%) 88% 90% ns Patient survival (%) 98% 98% ns Final serum creatinine (mg/dl) 1.4±0.3 1.4±0.6 ns Follow-up (months) 15±12 15±12 ns Among non-heart-beating donors, the causes of primary non-function were renal venous thrombosis (5), allograft rupture caused by acute rejection (2), and allograft rupture after a graft biopsy (1). Moreover, four more kidneys were lost despite primary graft function, one due to renal artery thrombosis, one due to hydronephrosis, and two patients died during follow-up. CONCLUSIONS Despite being associated with higher rates of primary non-function, and delayed graft function; the intermediate-term graft survival of non-heart-beating donors is very encouraging. It is our conclusion that, with an adequate infrastructure, people who die of cardiac arrest that occurs outside the hospital can be a viable source for kidney transplantation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e826-e827 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felipe Villacampa Madrid, Spain More articles by this author José Medina-Polo Madrid, Spain More articles by this author Federico de la Rosa Madrid, Spain More articles by this author Manuel Pamplona Madrid, Spain More articles by this author Alfredo Rodríguez Madrid, Spain More articles by this author Juan Passas Madrid, Spain More articles by this author José Manuel Duarte Madrid, Spain More articles by this author Eduardo Gutiérrez Madrid, Spain More articles by this author Teresa Dipalma Madrid, Spain More articles by this author Rafael Díaz Madrid, Spain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...