Non-heart-beating donors: is it worthwhile?

OBJECTIVE: Due to organ shortage in renal transplantation, many transplant centers attempt to increase the donor pool. Non-heart-beating donors seem to be a promising alternative. PATIENTS AND METHODS: We performed 14 renal transplantations from 8 non-heart-beating donors. 2, 1, 3 and 2 donors were from groups 1, 2, 3 and 4, respectively, according to Maastricht classification. RESULTS: In 6 of the patients' warm ischemia time was over 30 minutes. Three of them had primary non-function. In 6 patients delayed graft function was seen. The remaining 5 kidneys functioned immediately. Two patients whose kidney functioned returned to hemodialysis in the I I and 13th months after their transplantations. One of the patients with primary non-function died. 9 kidneys function well in their follow-up period between 5-111 months. 1 and 5-year graft survival rates were 69.8 and 61.1 percent, respectively. The mean graft survival time is 69.9 +/- 14.5 months. CONCLUSION: Despite the high primary non-function rate, we think that non-heart-beating donors especially in Maastricht classification 3 and 4 should be used due to dramatic shortage of organs.

Tuberculosis in renal transplant recipients on various immunosuppressive regimens.

BACKGROUND: Mycophenolate mofetil (MMF) and tacrolimus (TAC) are more potent than conventional immunosuppressive drugs, i.e. azathioprine, cyclosporin and prednisolone, and may be associated with an increase in the incidence of infections in the post-transplantation (post-tx) period. The aim of this study was to determine if the use of either or both of MMF and TAC for immunosuppression in renal transplant recipients increases the prevalence or modifies the clinical presentation of tuberculosis (TB), when compared with conventional therapy. METHODS: The medical records of 443 adult patients who received a kidney transplant between 1994 and 2002 were reviewed retrospectively. Comparisons were made between patients who had conventional immunosuppressive treatments (cyclosporin, azathioprine and prednisolone) or an alternative regimen (including MMF, TAC or both). RESULTS: We found 20 patients (4.5%) to have post-tx TB. There were 13 cases of TB (age 38.9+/-10.6 years) among 328 patients who received conventional immunosuppressants (group I) (4.0%) and seven cases (age 24.2+/-7.4 years) among 115 (6.1%) who received an alternative immunosuppressive regimen (group II) (P>0.05). The patients in group II were younger than the patients in group I (P = 0.002). A significantly higher number of patients in group II developed TB within the first 6 months post-tx (P = 0.042). However, there was no significant difference between the two groups regarding clinical and radiographic presentations or outcomes. CONCLUSIONS: Immunosuppression with TAC or MMF is associated with the development of TB earlier in the post-tx period and in younger patients.

Marginal donors in kidney transplantation.

BACKGROUND: Due to organ shortage, it is not easy to find an ideal donor in renal transplantation. To enhance donor pool, marginal donors can be acceptable even in living renal transplantations. We compared optimal and marginal donor transplantations in terms of graft and patient survival. METHODS: We performed 32 living related renal transplantations, 11 of which were from marginal donors, from January 1999 to December 2000. Recipients from optimal and marginal donors were compared in terms of renal function, acute tubular necrosis (ATN) and acute rejection (AR) rates. RESULTS: Although mean serum creatinine level in the seventh day was found to be higher in the recipients from marginal donors (1,88 mg/dl vs. 2,51 mg/dl); it did not reach to a statistical difference (p = 0.1). Serum creatinine levels after thirtieth day, ATN and AR rates were statistically similar in both groups, as well. In optimal and marginal groups, 3-year graft survival rates were found to be 85 and 72 percent respectively (p = 0.72). 3-year patient survival rates were also found to be similar in both groups (90% vs. 91%) (p = 0.91). CONCLUSION: Functional and survival results in the transplantations from marginal donors were as good as from optimal donors. So, we thought that marginal donors could be used safely with a good preoperative evaluation to increase donor pool.