Analysis of Causative Factors of Non-Function Kidney in 2453 Kidney Transplants from Non-Heart-Beating Deceased Donors

Abstract

Introduction: Recently the donor criteria have been expanding so as to overcome the organ shortage. Kidney transplants (KTx) from non-heart-beating deceased donor (NHBDD) are considered to be one of options despite the increasing risk of non-function kidney (NFK). Methods: Causative factors of NFK in 2453 KTx from NHBDD were investigated. The mean age was 46.2±16.8 (0˜76) y.o. for donor and 44.8±11.6 (8˜86) y.o. for recipient. The mean mismatched number (MMN) of HLA was 0.21±0.44 for DR and 1.46±1.05 for AB. The mean warm ischemic time (WIT) and total IT (TIT) were 7.8±9.8 (0˜70) min and 10.9±4.4 (2.5˜38.6) hr, respectively. The latest serum creatinine (sCr) of donors was 2.24±2.16 (0.28˜16.20). Donor status (age, gender, cause of death, sCr, anuria, hypotension and body temperature), WIT, TIT, catheter insertion for in situ perfusion after cardio-circulatory determination of death, controlled (Category 3)/uncontrolled (Category 2,4 and 5), types of preservation solutions, MMN of HLA and immunosuppressants were investigated as causative factors of the incidence of NFK by monovariate and multivariate analyses. All data were collected from 142 institutes by Japan Organ Transplant Network. Results: The NFK occurred in 198 cases out of 2435 (8.1%), and causes of NFK were primary non-function (84), rejection (28), thrombosis (23), death (35) and others. The donor gender, the latest sCr, body temperature and the duration of anuria and hypotension before organ recovery did not influence the incidence of NFK. Catheter insertion for in situ perfusion and Category 3 reduced the incidence of NFK (6.9% vs 10.7%, 5.3% 8.7%). As for WIT and TIT, the incidence of NFK was 7.8% for less than 5 min, 7.5% for 6-15 min, 9.3% for 16-30 min, 30.8% for over 31 min, 5.5% for less than 12 hr, 11.9% for 12-24 hr and 13.8% for over 24 hr. In the multivariate analysis, the relative risk of NFK was 5.419 (p=0.0004) for more than 31 min of WIT and 2.025 (p=0.0080) for more than 12 hr of TIT. Conclusion: WIT and TIT were the most important contributing factor to NFK in kidney transplants from NHBDD.