THE EARLY AND LONG-TERM GRAFT SURVIVALS OF CADAVERIC KIDNEYS HARVESTED FROM UNCONTROLLLED NON-HEART BEATING DONORS

Abstract

73 INTRODUCTION; In this clinical communication, the early and long-term posttransplant outcome of 285 renal allografts harvested from uncontolled non-heart beating donors (NHBDs), using in situ cooling technic, and transplanted into recipients treated with ciclosporin or tacrolimus are retrospectively investigated and risk factors affecting renal prognoses are analysed. STUDY SUBJECTS AND METHODS; Between April 1979 and December 1998, 379 kidneys been retrieved from 191 uncontrolled NHBDs using in situ cooling technic at our center. Thirty five kidneys (9.2%) were discarded mainly due to poor arterial perfusion and bacterial contaminations, and 39 kidneys were transplanted into patients treated with azathioprine and steroid. Among the rest, 285 kidneys engrafted before December 1998 and transplanted into recipients treated with ciclosporin or tacrolimus were enrolled. RESULTS; Following transplants, only 46 grafts (16.1%) had immediate graft function, and 17 grafts (6.0%) were lost due to primary non-function. Two hundred twenty two grafts (77.9%) required posttransplant dialysis (PTD) for 13.7 days on the average. The mean values of posttransplant lowest serum creatinine levels (LSCR) was 1.58 mg/dl. The patient survival at one, 3, 5 and 10 years were 97.2%, 95.0%, 93.2% and 89.3%, respectively, and the graft survival at one, 3, 5 and 10 years were 83.3%, 72.0%, 64.7% and 48.6%, respectively. When the donor's age, warm ischemic time (WIT) and total ischemic time (TIT) were analyzed with the LSCR and PTD period, only the donor's age had significant correlation with LSCR and PTD period (p < 0.001 and p < 0.01, respectively). Additionaly, renal grafts from the donors died of cereblovascular disease (CVD) had significantlly higher LSCR than the grafts from non-CVD donors (P < 0.0001). When multivariate analysis was applied for the long-term graft survival, WIT (> 30 min.) and donor age (> 50 years) were significantly independent risk factors (P< 0.001 and P< 0.05, respectively). CONCLUSIONS; The renal grafts harvested from uncontrolled NHBDs using in situ cooling technic can provide good renal functions and promise an acceptable long-term graft survial. Especially when the donor is young or the cause of death is non-CVD, the posttransplant renal function and graft survival will be excellent. We conclude using the kidneys from uncontrolled NHBDs should be one of the way to resolve the severe organ shortage.