Excellent Kidney Transplant Outcome using Non-heart Beating Donor Kidneys

Abstract

425 INTRODUCTION: The donor organ shortage has led transplant (Tx) centers to use marginal donors, not being considered as the organ sources previously. The non-heart beating donors (NHBD) often cause delayed graft function (DGF) and primary non-function (PNF). Despite the immunosuppressive ability of cyclosporine (CsA), grafts with prolonged warm ischemic time (WIT) is likely to be affected by CsA nephrotoxicity. In this standpoint, the quadruple immunotherapy (QIT) with low-dose CsA was established and the effects on the kidney Txs using NHBD grafts were evaluated. METHODS: Since October 1990, 69 cadaveric kidney Txs were underwent using NHBD grafts harvested under in situ cooling technique. The donor and recipient ages ranged from 3 to 67 years (mean 45.5 y/o) and from 15 to 59 years (mean 39.6y/o), respectively. WIT ranged from 1 to 52 minutes (mean 10.2 mins). CsA administration was started immediately post Tx settled at the initial dose 4 mg/kg/day and the dose was adjusted according to the trough level. Besides CsA, steroid, antilymphocyte globulin (ALG) and azathioprine (AZ), later replaced by mizoribine (MZ), were employed as QIT. RESULTS: Under QIT, 68 transplants were followed for 1 to 87 months post Tx. Seventeen grafts (24.6%) developed immediate function and 51 grafts (73.9%) showed DGF with 13.4 days in mean ATN period. One PNF case was noted because of a donor DIC kidney. Although acute rejection was noted in 28 cases, all grafts recovered function by steroid pulse and additionak OKT-3 rescue therapy in 5 cases. Overall patient and graft survival was 96.9% and 95.4% at one year, 95.3% and 93.6% at 3 year and 90.0% and 81.2% at 5 year, respectively. These data indicated that Tx outcome of NHBD grafts under QIT with low dose CsA is superior to UNOS data most of which are dealing with heart-beating brain dead donor grafts. CONCLUSIONS: Even with the high frequency of DGF, the quadruple therapy, consisting of low-dose CsA, steroid, ALG and AZ (later to MZ), provide the excellent graft function as well as long-term graft survival using NHBD grafts.