NON-HEART-BEATING DONOR KIDNEYS IN THE NETHERLANDS, ALLOCATION AND OUTCOME OF TRANSPLANTATION

Abstract

O398* Aim: Kidneys from non-heart-beating (NHB) donors have successfully been transplanted in the Netherlands since the early eighties. Currently one third of all renal transplantations in the Netherlands are with kidneys from NHB donors, a higher rate than anywhere else in the world. In the Netherlands we have a national waiting list managed by the Dutch Transplant Foundation (NTS). Kidneys from both heart beating (HB) and NHB donors are indiscriminately allocated through the regular renal allocation system. Hence all Dutch renal transplant candidates on the waiting list are potential NHB kidney recipients. Methods: In this abstract we report the 3 and 12 months outcome data of all renal allograft transplanted in the Netherlands between 1-2-2001 and 1-03-2002. Outcome data for kidneys from NHB donors were compared to those of HB donors. Recipient and donor factors were analyzed and the following outcome measures assessed: renal function and allograft survival rate, both at three and twelve months. Risk factors for graft failure were evaluated in a Cox proportional hazard model. Results: In the study period 332 adult patients received a kidney, 221 from a HB donor and 111 from a NHB donor. 17 (7.7%) HB and 16 (14.5%) NHB kidneys failed within 3 months (p=0.05). The 12 month graft survival rate was 90% and 82.7%, for HB and NHB respectively (p=0.06). Both at 3 and 12 months after transplantation serum creatinin was comparable in the two groups (152 mmol and 144 mmol) and (158mmol and 145 mmol) for HB and NHB respectively (p=0.4). Multivariate analysis identified a previous kidney transplantation (RR 2.9 (p=0.01)), a donor creatinin of > 150mmol (RR 3.8 (p=0.003)), and a prolonged warm ischaemic time (≥30 minutes) (RR 6.7 (p<0.001)), as independent risk factors for transplant failure within 12 months. No difference in 12 months graft survival was seen between HB and NHB kidneys after excluding the kidneys which failed in the first three months after transplantation. Conclusion: Kidneys from NHB donors are an important addition to the organ pool. The incidence of graft failure within three months is significantly higher in recipients of kidneys from NHB donors. After correction for early failure graft survival in HB and NHB kidneys is comparable at 12 months Twelve months after transplantations there is no difference in renal function between the study groups.