Early prognoses of 200 renal allografts harvested from non-heart-beating cadavers.

ABSTRACT

When the concept of brain death is not widely accepted, the viability of renal allografts of non-heart-beating cadaveric donors is one of the serious concerns for transplant surgeons. At our center, 200 kidneys were harvested from cardiac arrest donors using the regional in situ cooling technique, and they were transplanted into recipients treated with cyclosporine (CS). The ages of donors ranged from 7 months to 67 years. At the bedside a specially designed double balloon catheter, 14F, was inserted into the aorta through the femoral artery just before or immediately after the cardiac arrest. A venous drainage tube was also placed in the vena cava. Following the cardiac arrest, both balloons of the aortic catheter were inflated, and regional in situ cooling with cold Lactate Ringer's solution started using the infusion pump at 20 mL/kg/min. In the OR, both kidneys were removed en bloc and preserved in Collins'type solution. They were then transplanted into 200 patients treated with CS and steroid. After the transplant operations, 33 patients (16.5%) had immediate renal function, but 14 grafts (7.0%) were not successful and the patients have never had renal function. When several factors such as donor age, warm ischemic time (WIT; 12.3 ± 14.1 minutes), in situ cooling time (IST; 78.1 ± 18.0 minutes) and total ischemic time (TIT; 619 ± 340 minutes) were associated with the post-transplant renal function, only the donor age had significant correlation both with the posttransplant dialysis period and lowest serum creatine level, as follows 10.5 days ( ≤ 40 years) vs. 14.6 days ( > 40 years); P < 0.05, and 1.16 mg/dL ( ≤ 30 years) vs. 1.83 mg/dL ( > 50 years) P < 0.001, respectively. Our findings indicate; 1) Due to the in situ cooling technique, the renal grafts of non-heart-beating cadavers can be expected to have relatively good function in the CS-treated recipients; 2) donor age is instrumental in predicting post-transplant renal function as well as the duration of ATN; 3) WIT, 1ST and TIT have no association with the post-transplant renal function if the duration of renal ischemia is within the acceptable range.