Long-term graft survival after transplantation with kidneys from uncontrolled nonheartbeating donors

Background. Notwithstanding the widely acknowledged organ-donor shortage co upled with the expanded waiting list for organs, many transplant programs h ave been reluctant to use kidneys from nonheartbeating donors. Some reasons expressed by those programs include a higher rate of delayed graft functio n, additional dialysis requirements, more medication usage, and inferior gr aft survival rates, To refute the common misperceptions, we reviewed our 4- year experience with 31 nonheartbeating donor kidneys recovered from uncont rolled donors (Maashticht classification) at our institution. Methods. After cardiac arrest and declaration of death, all donors underwen t intravascular and intraperitoneal cooling, Immediately after bilateral en bloc nephrectomy, kidneys were placed on the Waters MOX pulsatile preserva tion machine. Preservation parameters were monitored hourly, using pharmaco logic agents (Stelazine, dexamethasone, Humulin R) as indicated by those pa rameters. Results. The nonheartbeating donors ranged in age from 15 to 53 years, 83% were males, and 60% of deaths were caused by trauma. For the 21 recovered a nd transplanted at our center, delayed graft function occurred with 16 kidn eys; there was no primary nonfunction, There was no obvious correlation bet ween functional status and donor age. It was noted that the immediate-funct ion kidneys had shorter warm ischemia and total preservation times compared with the delayed graft function group. Nineteen of the 21 grafts continue to function. All patients are surviving. Conclusions. This series suggests that to obtain excellent results with non heartbeating donor kidneys certain principles should be followed: use machi ne preservation to resuscitate and evaluate viability, choose immunological ly low-risk recipients, avoid immediate exposure to immunophilin antagonist s, and perform biopsy frequently for allograft dysfunction to exclude low-g rade rejection.