Are kidneys from non-heart-beating donors second class organs?

Butterworth, P.C.; Taub, Nick; Doughman, T; Horsburgh, T.; Veitch, P. S.; Bell, P. R. F.; Nicholson, Michael L.

doi:10.1016/s0041-1345(97)01143-3

Cited by 16 publications

(12 citation statements)

References 2 publications

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“…The PNF average rate in the current study was 6.17% which is consistent with the 8 – 15 % reported previously from NHBDs55,91. This is higher than 2–5% quoted for HBD kidneys26,92. Shiroki et al93 claimed that PNF rate is highest in those NHBD kidneys with warm time of > 30 min.…”

Section: Discussionsupporting

confidence: 92%

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Non Heart-Beating Donors in England

Chaib

2008

Clinics

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Chaib E. Non heart-beating-donors in England. Clinics. 2008;63(1):121-34. When transplantation started all organs were retrieved from patients immediately after cardio-respiratory arrest, i.e. from nonheart-beating donors. After the recognition that death resulted from irreversible damage to the brainstem, organ retrieval rapidly switched to patients certified dead after brainstem testing. These heart-beating-donors have become the principal source of organs for transplantation for the last 30 years. The number of heart-beating-donors are declining and this is likely to continue, therefore cadaveric organs from non-heart-beating donor offers a large potential of resources for organ transplantation. The aim of this study is to examine clinical outcomes of non-heart-beating donors in the past 10 years in the UK as an way of decreasing pressure in the huge waiting list for organs transplantation. KEYWORDS:Transplantation. Liver. Kidney. Donors.The imbalance between supply of organs for transplantation and demand for them is widening all over the world. In the United Kingdom (UK) the figures are not different, by the end of December 2004 there were over 6000 people on the active waiting list for organ transplantation. Recent data suggest that over 400 of these people will die each year before a new organ becomes available.

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Section: Discussionsupporting

confidence: 92%

“…There is disagreement in the literature over NHBD post-transplant renal function. In some studies NHBD kidneys achieved early serum creatinine levels in the normal range26,49,58,108,109 whist others studies reported poor graft function than HBD in both the short and medium term73,91.…”

Section: Discussionmentioning

confidence: 99%

Non Heart-Beating Donors in England

Chaib

2008

Clinics

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“…Some studies show a significantly higher serum creatinine in non-heart beating kidneys, however 55% of non-heart beating kidneys achieve normal post-transplant renal function 78 13 Another observation after non-heart beating kidney transplantation is that delayed graft function (an episode of post-transplant dialysis) is particularly common with rates ranging from 67%–100% 7-912-15 This is compared with a delayed graft function rate of 19%–35% in cadaveric heart beating donor kidneys 7…”

Section: Resultsmentioning

confidence: 99%

“…12-15 This is compared with a delayed graft function rate of 19%–35% in cadaveric heart beating donor kidneys 78 12 13 The rate of permanent (primary) non-function in non-heart beating donor kidneys is also relatively high (6%–14%) compared with 1%–8% in cadaveric renal transplant kidneys 7-912-15 Primary non-function in heart beating cadaver grafts is thought to be due, in the majority of cases, to cortical ischaemic necrosis.…”

Section: Resultsmentioning

confidence: 99%

Use of non-heart-beating donors in renal transplantation

Kimber

Metcalfe

White

et al. 2001

Postgraduate Medical Journal

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The rate of renal transplantation has plateaued and is now limited by the number of donor organs available. In the past all donor kidneys came from living donors or controlled non-heart beating donors. It was not until the introduction of brainstem death criteria that cadaveric heart beating donors became the main source. Recently, there has been renewed interest in non-heart beating donors, who have already suVered cardiorespiratory arrest. Kidneys from these donors have a unique set of problems associated with increased duration of warm ischaemia. To minimise this, the kidneys are cooled in situ using an intra-aortic balloon catheter and are perfused with cold hyperosmolar citrate. Retrieval can then proceed in the normal fashion. Despite a higher level of delayed graft function, the results from non-heart beating renal transplantation are good, with long term function comparable to cadaveric organs. If used safely, they enable significant expansion of the donor pool. Techniques in the future, such as machine perfusion preservation, may further improve the results from non-heart beating programmes. (Postgrad Med J 2001;77:681-685)

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“…Kidneys from DCD may increase the donor pool by 25–40% [2–5] and have shown similar long‐term graft survival to kidneys from conventional deceased donors after brain death (DBD) [6–10]. However, the high incidence of delayed graft function (DGF) associated with these organs has limited or even precluded their routine use in many transplant units [11–12]. DGF complicates post‐transplant management, increases the duration and costs of hospitalization, and has an adverse effect on long‐term graft survival [13–17].…”

Section: Introductionmentioning

confidence: 99%

Impact of pulsatile perfusion on postoperative outcome of kidneys from controlled donors after cardiac death

Plata-Muñoz¹,

Muthusamy²,

Quiroga³

et al. 2008

Transplant International

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Summary Pulsatile perfusion (PP) might be a cost‐effective cold preservation technique to reduce the incidence of delayed graft function (DGF) in kidneys from deceased donors. With the aim to address whether PP can reduce the incidence of DGF in kidneys from controlled donors after cardiac death (cDCD), we compared the clinical outcome of 30 recipients of kidneys from cDCD preserved by static cold storage (cDCD‐SCS) with 30 recipients of cDCD kidneys preserved by PP (cDCD‐PP). The end‐points were the incidence of primary nonfunction (PNF), DGF and acute rejection (AR), the length of hospitalization, 1, 3, 6 and 12‐months graft function, graft survival and patient survival. Donor, recipient and preimplantation data were well matched. DGF was significantly lower (53.3% vs. 86.6%P < 0.001) and the length of hospitalization shorter (10 vs. 14 days P < 0.033) in the cDCD‐PP group. Similarly, postoperative and short‐term graft function (7 and 30 days and 6 and 12 months, respectively) was statistically better in the cDCD‐PP than in the cDCD‐SCS. In summary, in this cohort, clinical introduction of PP was associated with a significant reduction of DGF, shorter hospitalization and better graft function than SCS.

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Are kidneys from non-heart-beating donors second class organs?

Cited by 16 publications

References 2 publications

Non Heart-Beating Donors in England

Non Heart-Beating Donors in England

Use of non-heart-beating donors in renal transplantation

Impact of pulsatile perfusion on postoperative outcome of kidneys from controlled donors after cardiac death

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