Papers

Renal grafts from non-heart beating donors

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6928.575a (Published 26 February 1994) Cite this as: BMJ 1994;308:575
  1. A O Phillips,
  2. S A Snowden,
  3. A N Hillis,
  4. M Bewick
  1. Renal Unit, King's College Hospital (Dulwich), London SE22 8PT
  1. Correspondence to: Mr Bewick.
  • Accepted 17 December 1993

During 1990 in Britain 60.7 patients per million of the population were accepted for renal transplantation but fewer than 35 patients per million received a renal transplant.1 More transplants would be available if non-heart beating donors were used.*RF 2-4* We report a retrospective study of transplantation of renal grafts from non-heart beating donors.

Patients, methods, and results

From 1 September 1988 to 30 April 1991, 27 patients received renal transplants from non-heart beating donors and 70 from heart beating donors. Nine of the non-heart beating donors (who donated 18 grafts) had been hospice patients with primary cerebral tumours. The hospice's counsellors had sought consent both from the patients and from their relatives. During the terminal phase of their illness the patients received only the treatment indicated by their medical condition. After the patient's death the family was given time to be with him or her before the body was moved to the hospice's mortuary and the kidneys were removed. The remaining grafts came from people who had died after road traffic accidents or of myocardial infarction or subarachnoid haemorrhage. Donors and recipients were matched according to ABO blood group and a negative result on lymphocytotoxicity testing; no account was taken of the source of the graft. All patients received immunosuppressive drugs.

We used Student's t test, the X2 test, and the log rank test for analysing the data.

Recipients of grafts from non-heart beating donors were older (mean age 55 (SD 15)) than recipients of grafts from heart beating donors (47 (17)) (P<0.05). The mean age of the non-heart beating donors was 40 (13) and of the heart beating donors 41 (19) (NS). Eight grafts never functioned; seven were from non-heart beating donors. Of the kidneys that eventually functioned nine (47%) from non-heart beating donors and five (7%) from heart beating donors showed primary non-function (no reduction in the serum creatinine concentration during the first week after transplantation).

The two year actuarial survival of the grafts from non-heart beating donors was 55% and of the grafts from heart beating donors 71% (P>0.1) (figure). The relative risk of failure of the grafts from non-heart beating donors (regardless of the time to failure) was 1.61 (95% confidence interval 0.94 to 3.14).5 The mean serum creatinine concentrations in the two groups did not differ significantly at any time during the first two years after transplantation. Mortality in the patients given a graft from a non-heart beating donor was 22% (six patients, five of whom died in the first six months after transplantation). Mortality in those given a graft from a heart beating donor was 15% (P>0.5).

Figure1

Actuarial survival of renal grafts from non-heart beating donors compared with heart beating donors. Figures indicate number of grafts at risk during each period

Comment

The considerably (though not significantly) poorer survival of grafts from such donors compared with those from heart beating donors is not at first encouraging. Twelve of the 27 grafts from non-heart beating donors were lost: six of the 12 recipients died, three with functioning grafts and three with non-functioning grafts. The other grafts were lost because of a haemorrhage in a functioning graft induced by biopsy at day 10, a renal vein thrombosis in a patient with antithrombin III deficiency, an early graft infarction in a patient with the anti-epithelial antibody, postoperative bleeding, and severe vascular rejection (two cases).

The higher frequency of primary non-function in kidneys from non-heart beating donors is to be expected as the kidney is removed up to 45 minutes after the heart has stopped beating.

In this study the mortality and graft survival were worse in patients who had received grafts from non-heart beating donors than in those who had received them from heart beating donors. The higher mean age of the former group may partly explain this. Five of the seven grafts that never functioned were transplanted into patients over 65. The results nevertheless indicate that non-heart beating donors can be a source of renal transplants for some patients.

References

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