Victims of cardiac arrest occurring outside the hospital: a source of transplantable kidneys.

Abstract

BACKGROUND The use of non-heart-beating donors could help shorten the list of patients who are waiting for a kidney transplant. Several reports describe acceptable results of transplantations from non-heart-beating donors who had in-hospital cardiac arrest, but few reports describe results of transplantations from non-heart-beating donors who had cardiac arrest that occurred outside of the hospital (Maastricht type I and type II donors). OBJECTIVE To compare graft survival rates among patients receiving kidneys from heart-beating donors versus type I or type II non-heart-beating donors. DESIGN Retrospective cohort study of transplantations performed from January 1989 to December 2004. SETTING Kidney transplant program of a teaching hospital in Madrid, Spain. PATIENTS 320 patients who received a kidney transplant from non-heart-beating donors (273 type I donors and 47 type II donors) and 584 patients who received a kidney transplant from heart-beating donors divided into 2 groups according to donor age (age <60 years [n = 458] and age > or =60 years [n = 126]). MEASUREMENTS The primary outcome measure was graft survival. The median follow-up time was 68 months (range, 9 to 198 months). RESULTS One- and 5-year graft survival rates were 90.7% and 85.5%, respectively, for transplants from heart-beating donors younger than 60 years of age; 79.8% and 73.3%, respectively, for transplants from heart-beating donors 60 years of age or older (P < 0.001); and 87.4% and 82.1%, respectively, for transplants from non-heart-beating donors (P = 0.22 [vs. those from heart-beating donors < 60 years of age] and P = 0.014 [vs. those from heart-beating donors >or = 60 years of age]). Graft survival did not differ between patients who received kidneys from heart-beating donors younger than 60 years of age and patients who received kidneys from non-heart-beating donors. LIMITATIONS This single-site, observational study was retrospective, and immunosuppressive therapy regimens given to transplant recipients varied over time. CONCLUSIONS Outcomes of transplants from non-heart-beating donors and younger heart-beating donors are similar, and results for transplants from non-heart-beating donors improved compared with those from older heart-beating donors. On the basis of these results, the authors encourage other transplant units to adopt the use of type I and type II non-heart-beating donors.

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@article{SnchezFructuoso2006VictimsOC, title={Victims of cardiac arrest occurring outside the hospital: a source of transplantable kidneys.}, author={Ana I S{\'a}nchez-Fructuoso and Maria Marques and Dolores Prats and Jos{\'e} Conesa and Natividad Calvo and M Jes{\'u}s P{\'e}rez-Cont{\'i}n and Jes{\'u}s Blazquez and Cristina Fern{\'a}ndez and Ervigio Corral and Francisco Del R{\'i}o and Jose R N{\'u}{\~n}ez and Alberto Barrientos}, journal={Annals of internal medicine}, year={2006}, volume={145 3}, pages={157-64} }