P114 Aims: Because of a world-wide shortage of cadaveric renal allografts, kidneys procured from non-heart beating donors (NHBDs) have been recently taken as the optional resource for the renal transplants in some European countries and United States. In Japan, most of the cadaveric kidneys have been from the NHBDs for almost 3 decades, and the most serious concern of Japanese transplant surgeons has been “How to minimize the warm ischemic time (WIT)?”. In this clinical communication, an excellent posttransplant outcome of the cadaveric renal allografts, harvested from NHBDs using in situ regional cooling technique, is reported. Methods: Between November 1990 and January 2004, 93 kidneys were harvested from NHBDs using in situ cooling technique. The ages of donors ranged from 3 to 71 years (mean; 46.7 years). Sixty seven donors died of cerebrovascular accident, 19 died of head injury, 5 died of suicide and 2 died of brain tumor. When the diagnosis of brain death was made by the neurophysicians and the consent of kidney donation was obtained from the persons next to kin, a specially designed triple-lumen, double-balloon catheter was inserted into the aorta through a femoral incision at the bed side. After the cardiac arrest of the donor, both the balloons were inflated and cold Lactated Ringer solution was rapidly infused into the aorta through the aortic catheter using a infusion pump. For the venous drainage, a gastric tube inserted into the vena cava was used. WIT, defined as the period between the cardiac arrest and the beginning of in situ cooling, ranged from 1 to 52 minutes (mean; 9.6 minutes). Those 93 grafts were transplanted with the total ischemic time ranging from 325 to 2603 minutes (mean; 1005 minutes). The ages of recipients ranged from 15 to 63 years (mean; 42.1 years). The recipients’ pretransplant dialysis periods ranged from 12 to 300 months (mean; 106 months). Seventy seven patients were treated with cyclosporine (CsA), methylprednisolone (MP), anti-human lymphocyte globulin and azathioprine or mizoribine, 10 were treated with CsA, MP and mycophenolate mofetil (MMF) and 6 were treated with tacrolimus, basiliximab, MMF and MP. Results: Following renal transplants, the immediate graft function was noted in 21 recipients (21.5%), and 71 patients (76.1%) had delayed graft function necessitating posttransplant dialyses for one to 39 days (mean; 9.4 days). One graft (1.1%) never recovered the renal function. Ten patients died; 3 due to chronic hepatic failures, 2 due to heart failures, 2 due to malignancies, one due to peritonitis following massive duodenal ulcer bleeding, one due to sepsis and one due to an accident. Thirteen patients lost the grafts; 12 due to chronic rejection and one due to non-compliance. The 1, 3, 5, and 10 year patient survival rates are 97.8%, 95.4%, 92.9% and 87.9%, and the 1, 3, 5 and 10 year graft survival rates are 96.7%, 94.3%, 87.9% and 66.1%, respectively. Conclusions: (1) Applying in situ regional cooling technique, renal allografts procured from NHBDs provided an excellent graft survival. (2) NHBDs should be considered as one of the excellent organ resources.