Expansion of donor pool: lack of function predictors

Balupuri, S.; Abusin, K.; Gerstenkorn, C.; Manas, DM; Talbot, David

doi:10.1111/j.1432-2277.1999.tb00599.x

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…The estimated 1-year graft survival in this program is 82.9%, comparable to kidney graft survival in the United Kingdom between 1987 and 1993 [33]. Before extending the use of NHBDs in other centers, the current difficulties and lack of reliable viability parameters must be considered and solved [34]. Further research and experience with these donor organs are required at present before recommending this approach more widely.…”

Section: Discussionmentioning

confidence: 90%

Non‐heart‐beating Donors: Renewed Source of Organs for Renal Transplantation during the Twenty‐first Century

Gerstenkorn

2003

World j. surg.

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The growing demand of organs for renal transplantation makes it necessary to explore alternative routes for kidney donation. Non-heart-beating donors (NHBDs) are a valuable source of cadaveric organs and have been the subject of renewed interest in recent years. In addition to difficulties with legal and ethical acceptability, there are concerns regarding medical safety. The current NHBD program at St. George's Hospital in London was started in March 1995. A total of 41 kidneys from category I to III donors (according to the Maastricht classification) were retrieved from the Accident and Emergency Department and several intensive care units and were subsequently transplanted. Cold in situ perfusion was commenced via femoral access or rapid aortic cannulation in most donors. Of these transplanted kidneys, 35 started functioning within 4 weeks. The permanent nonfunction (PNF) rate was 14.6% (6/41) and the estimated 1-year graft survival 82.9% (34/41). The delayed graft function (DGF) rate (defined as recipients requiring posttransplant dialysis for 3 days or longer) was 80.0% (28/35). The median serum creatinine concentration in patients with a functioning graft at 1 year was 165 micromol/L. NHBD kidneys have contributed about 15% to the regional transplant activity over the last 6 years, even though not all potential NHBDs were used. It was possible to lower the PNF rate with strict donor selection criteria and more recently with pulsatile machine perfusion. NHBDs represent a valuable source for kidneys and can extend the donor pool. More experience is currently needed to continue to lower PNF rates reliably before promoting more widespread use of NHBDs for renal transplantation.

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Section: Discussionmentioning

confidence: 90%

Non‐heart‐beating Donors: Renewed Source of Organs for Renal Transplantation during the Twenty‐first Century

Gerstenkorn

2003

World j. surg.

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“…have led to impaired long-term graft survival 14, 191. If it is accepted that the incidence of DGF in NHBD programmes is high, and efforts are made to incorporate this factor into post-transplant management, as was done within the South Thames region, DGF will not be associated with impaired graft function in such programmes. Lowering of permanent non-function rates in NHBD kidneys, and reliable viability tests for kidneys prior to transplantation still remain challenging issues for a successful NHBD programme [2].…”

Section: Discussionmentioning

confidence: 99%

Outcome of renal allografts from non-heart-beating donors with delayed graft function

Gerstenkorn¹,

Deardon²,

Koffman³

et al. 2002

Transplant International

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Delayed graft function (DGF) in renal transplantation using non-heart-beating donors (NHBDs) usually exceeds 80%. There is debate whether DGF in this subgroup is associated with poor long-term outcome. Between 1 January1988 and 3 1 January 2000, 130 of 158 (82.3%) NHBD graft recipients with functioning grafts transplanted within our regional NHBD programme developed DGF. Overall graft survival and graft survival censored for recipient death was 1 I3/ 130 (86.9%) versus 113/121 (93.4%) at year I, 55/84 (65.5%) versus 55/64 (85.9%) at year 5 and 18/40 (45.0%) versus 18/28 (64.3%) at year 10 after transplantation. Seventeen grafts (I 3 . I YO) were lost due to rejection or graft nephropathy. Nine of these kidneys failed during the 1st year. Twenty-seven patients (20.8%) died with functioning grafts, eight within the 1st year after transplantation. In those patients who survived, DGF was associated with excellent longterm outcome in this study. The number of grafts lost due to recipient death exceeded those lost due to rejection or graft nephropathy.

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