ANALYSES OF CONTRIBUTING FACTORS TO EARLY GRAFT FUNCTION IN 1279 KIDNEY TRANSPLANTS FROM NON-HEART-BEATING DECEASED DONORS.

Abstract

O394* Aims: Kidney transplant (KTx) from non-heart-beating donors (NHBD) would be one of the countermeasures dealing with organ shortage. In the present study, the contributing factors to influence early graft function after KTx from NHBD were investigated. Methods: Since April 1995, 1279 cases of deceased donor KTx were done from NHBD in Japan. In 876 cases among them, triple-lumen/double-balloon catheter (TR/DBC) for in situ perfusion (ISP) was inserted into abdominal aorta via femoral vessels before cardiac standstill (CS) and ISP was initiated after CS, while in remaining 403 cases inserted following laparotomy after CS. Graft survival rate (GSR), the rate of non-function kidney (NFK), posttransplant dialysis period (PDP) and posttransplant serum creatinine (sCr) level by donor status (age, gender, cause of death, sCr, anuria, hypotension and body temperature), warm and total ischemic time (WIT, TIT), TR/DBC insertion before or after CS, the discontinuation of ventilator and preservation solution were investigated. All data were collected from 173 KTx institutes by Japan Organ Transplant Network. Results: The mean age was 46.2±16.8 (1∼74) y.o. for donor and 44.8±11.6 (2∼72) y.o. for recipient. The mean WIT and TIT were 8.1±10.6 (0∼72) min and 14.1±6.6 (2.5∼38.6) hr. GSR for within 30 min of WIT was higher than GSR for more than 30 min of WIT at 3 (89.3 vs. 70.6%), 6 (88.0 vs. 65.6%) and 12 months (85.3 and 65.6%), respectively. GSR by TIT at 3, 6 and 12 months was 91.5, 90.9 and 88.8% for less than 12 hr, 86.0, 83.6 and 81.2% for 12 to 24 hr, and 84.0, 81.8 and 76.5% for more than 24 hr, respectively. With WIT less than 30 min, GSR by TIT at 3 and 6 months was 91.3 and 90.7 for less than 12 hr, 87.9 and 85.5% for 12 to 24 hr, and 85.9 and 85,1% for more than 24 hr. With WIT over 30 min, GSR by TIT at 3 and 6 months was 63.4 and 60.8% for 12 to 24 hr and 60.0 and 40.0% for over 24 hr, whereas 100 and 100% for less than 12 hr. Posttransplant sCr was significantly higher for over 30 min of WIT and/or over 12 hr of TIT at 3 months, while same at 6 months. TR/DBC insertion before CS significantly improved GSR, the rate of NFK and PDP as compared with after CS (p=0.0026, 0.01). In case with TR/DBC inserted before CS, the discontinuation of ventilator did not influence GSR, while with TR/DBC inserted after CS, GSR with ventilator discontinued (Maastricht Classification Category (MCC) 4) was superior to that with ventilator continued (MCC 3) (96.2 vs. 82.2% at 3, 94.2 vs. 80.1% at 6 months, p=0.0198). Donor age, sCr, body temperature, existence of anuria, duration of hypotension and the type of preservation solution did not influence GSR or the rate of NFK. Conclusions: WIT, TIT and the timing of TR/DBC insertion strongly influenced GSR, the rate of NFK and PDP.