KIDNEY-TRANSPLANTS FROM NON-HEART-BEATING DONORS - EXPERIENCE OF THE CLINIC-HOSPITAL-OF-BARCELONA

Despite the high rate of organ generation in Spain, an unbalance exist s between the number of kidneys procured and demanded. Kidneys from no n-heart-beating donors (NHBD) are currently accepted in order to incre ase th organ procurement rate. The aim of this study was to analyse th e results of NHBD renal transplant program in our institution. Between October 1986 and February 1996, 32 potential NHBD were registered. Of these, 29 were type II and 3 type IV according to Maastricht criteria . Nine donors were rejected due to clinical reasons, and family consen t was refused in 3 donors. 39 out of 40 available kidneys were finally transplanted. In these, mean donor age was 33.8 +/- 16.9 years (9-60) , mean warm ischemia time prior to patient resuscitation 9.2 +/- 8.2 m inutes (0-29) and total warm ischemia time was 59.5 +/- 0.5 minutes (5 -140). Immunosupression therapy consisted of Cyclosporine-Prednisone /- Azathioprine in 10 patients (26%) or sequential therapy with ATG in the other 29 (74%). Mean HLA-A,B,DR matching was 1.6 +/- 1.1. Mean co ld ischemia time was 18 +/- 6 hours (7-33). Five kidneys (12.5%) showe d primary non-function whereas delayed function was present in 24 (61. 5%). 50% of the patients experienced early acute rejection. Mean serum creatinine values at 1 and 3 years were 1.7 +/- 0.8 mg/dl and 2.4 +/- 1.6 respectively. Kidneys from donors preserved with total body cooli ng showed a trend to better renal function. for the entire study group , actuarial patient survival was 91% at 1 and 5 years, whereas graft s urvival was 76% and 46% respectively. The severity of acute tubular ne crosis (ATN) was evaluated by Tc-99 MAG-3 scintigraphy. Patients with a severe radionuclide ATN pattern showed a lower graft survival. In co nclusion: in our experience, the use of kidneys from NHBD results in a n acceptable rate of graft survival and provides a way of reducing the shortage of kidneys for transplantation. nevertheless, efforts should be made in order to achieve better results.