Long-term renal function in non-heart-beating donor kidney transplantation- A single-center experience

Background One of the most serious problems facing major transplant program s is the severe shortage of organs. Expansion of the donor pool to include nontraditional donors, such as non-heart-beating donors (NHBDs), would cons iderably expand the availability of organs. Methods. Between 1983 and 1996, we performed a total of 125 non-heart-beati ng cadaveric renal transplantations under cyclosporine-based or tacrolimus- based immunosuppression. Thirty-nine recipients were females and 86 were ma les. Total ischemic time (TIT) and warm ischemic time (WIT) were an average of 761+/-347 min (322-2027 min) and 7.4+/-13.1 min (0-45 min), respectivel y. Results. Of the 125 transplanted kidneys from NHBDs, 98 (78.4%) developed d elayed graft function (DGF), which lasted a mean of 16+/-21 days (range 3-3 7 days). One hundred and eight patients (86.4%) were off dialysis by the ti me of discharge. Of the 125 grafts, 11 (8.8%) were primary nonfunction. The average of the nadir of serum creatinine levels, which was evaluated using 108 patients who were off dialysis by the time of discharge, was 1.4+/-0.5 mg/dl. The lowest creatinine levels (nadir) were under 2.0 mg/dl in 98 (78 .4%) of the 125 patients. Acute rejection occurred in 64 (51.2%) of the 125 recipients, Patient survival rates were 90% at 5 years and 88% at 10 years . Graft survival rates were 65% at 5 years and 46% at 10 years. We tried to find the risk factors that affected graft survival. We examined the variou s possible risk factors, including harvesting condition (controlled versus uncontrolled), HLA-AB mismatches, HLA-DR mismatches, graft weight, donor ag e and sex, recipient age and sex, posttransplant DGF, acute rejection, WIT, and TIT. However, no significant risk factor was identified except acute r ejection. We tried to discover the risk factors that caused primary nonfunc tion. Possible risk factors, including donor age, TIT, WIT, graft weight, a nd harvesting condition were compared, but no significant risk, factor was identified. Long-term renal function was evaluated by serum creatinine leve ls. Serum creatinine levels at 1, 5, and 10 years were 1.76+/-0.7 mg/dl, 1. 7+/-0.96 mg/dl, and 1.53+/-0.6 mg/dl, respectively. Conclusions. In conclusion, our data demonstrated that the procurement of k idneys from NHBDs leads to acceptable long-term graft survival and renal fu nction, despite a high incidence of DGF.