Experience with liver and kidney allografts from non - Heart-beating donors

Adrian Casavilla, Carlo Ramirez, Ron Shapiro, Dai Nghiem, Kevin Miracle, Oscar Bronsther, Parmjeet Randhawa, Brian Broznick, John J. Fung, Thomas Starzl

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321 Scopus citations

Abstract

ana Aitegneny uenerai nospuai ana Given the shortage of cadaveric organs, we began a study utilizing NHBD for OLTx and KTx. There were 24 NHBD between January 1989 and September 1993. These donors were divided into 2 groups: Uncontrolled NHBD (Gl) (n=14) were patients whose organs were recovered following a period of CPR; and controlled NHBD (G2) (n=10) were patients whose organs were procured after sustaining cardiopulmonary arrest (CA) following extubation in an operating room setting. Eight kidneys and 5 livers were discarded because of macroscopic or biopsy ñndings. In Gl, 22/27 (81.5%) kidneys were transplanted; 14/22 (64%) developed ATN; 20/22 (95%) recipients were off dialysis at the time of discharge. With a mean follow-up of 32.7± 21.1 months, sixteen (73%) kidneys are still functioning, with a mean serum creatinine of 1.7±0.6 mg/dl. The one-year actuarial patient and graft survivals are 95% and 86%. In G2, 17/20 (85%) kidneys were transplanted; 13/17 (76%) kidneys experienced ATN. All patients were off dialysis by the time of discharge. With a mean follow-up of 17.6±15.4 months, twelve (70%) kidneys are still functioning, with a mean serum creatinine of 2.5±2.1 mg/dl. The one-year actuarial patient and graft survivals are 94% and 82%, respectively. In Gl, 6/10 (60%) livers were transplanted; 3/6 (50%) livers functioned, the other 3 patients required ReOLTx in the first week postoperatively because of PNF(n=2) and inadequate portal flow (n=l). Two functioning livers were lost due to HAT (n=l) and CMV hepatitis (n=l)ĝ In G2, 6/7 (85.7%) livers were transplanted. All the livers (100%) functioned. 2 patients required ReOLTx for HAT at 0.9 and 1.0 months. Both patients eventually died. One patient with a functioning liver died 2 months post OLTx. The remaining 3 patients are alive and well at 27 months of follow-up. This study shows that the procurement of kidneys from both uncontrolled and controlled NHBD leads to acceptable graft function despite a high incidence of ATN. The function of liver allografts is adequate in the controlled NHBD but suboptimal in the uncontrolled NHBD, with a high rate of PNF.

Original languageEnglish
Pages (from-to)197-203
Number of pages7
JournalTransplantation
Volume59
Issue number2
DOIs
StatePublished - Jan 1995
Externally publishedYes

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