THE FATE OF 359 RENAL ALLOGRAFTS HARVESTED FROM NON-HEART BEATING UNCONTROLLED CADAVERS AT A SINGLE CENTER

Abstract

426 OBJECTIVE: Since April 1979, 359 kidneys were harvested from 182 uncontrolled non-heart beating cadaveric donors (NHBDs) using regionalin situ cooling technic at our center. In this clinical communication, the fates of those grafts are retrospectively investigated and factors affecting the transplant (Tx) outcome are analysed. STUDY SUBJECT AND METHOD: The ages of donors ranged from 7 months to 70 years(average; 45.0 years old). Following the cardiac arrest, regionalin situ cooling was started at the bed side using a specially designed tripple lumen catheter and an infusion pump, and then the patient was brought to the operation room where the kidneys were harvested and cold stored. Out of the 359 kidneys, 35 kidneys were discarded mainly due to poor arterial perfusion or bacterial contamination, and 324 kidneys were engrafted at 24 hospitals including our center. Thirty nine grafts were transplanted into the recipients treated with azathioprine (AZA) and steroid, and 285 grafts were transplanted into the recipients treated with ciclosporin (CS) or tacrolimus (FK) and steroid. RESULT: Although the frequency of never functioning grafts in AZA group was significantly higher than that in CS/FK group, 20.5%(8 grafts) v.s. 6.0%(17 grafts), p<0.01, the frequencies of immediate renal function were not different, 15.4% and 17.3%, respectively. The duration of postTx dialysis on ATN as well as the lowest level of serum creatinine in each group were also not different (9.1 vs. 11.5 days, and 1.64 vs. 1.57 mg/dl, respectively.) The one, 5 and 10 year graft survival rates in the CS/FK group were 82.5 %, 65.5% and 53.0%, respectively. When several factors such as warm ischemic time (WIT), total ischemic time (TTT), donor age and cause of donor's death were evaluated using multivariate analysis, only the WIT (≥ 30 min.) and donors' age (≥ 50 years) were significant independent factors for the long term allograft outcome.CONCLUSION: 1) Using in situ cooling technic, the grafts from uncontrolled NHBDs reserved acceptable renal function. 2) The graft survival rate in the CS/FK treated recipientsis was not different from the up-to-date UNOS registry data. 3) WIT and donors' age had significant influences on the renal transplant outcome, although TIT and the cause of donor's death had poor effects. 4) NHBDs should be considered as the source of excellent renal allografts if WIT and donors' age are within acceptable ranges.