Victims of Cardiac Arrest Occurring Outside the Hospital: A Source of Transplantable Kidneys

1 August 2006 | Volume 145 Issue 3 | Pages 157-164

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 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 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.

Editors' Notes Context Waiting lists for kidney transplants are long. Contribution This study from Madrid, Spain, compared transplantation outcomes of 584 recipients of kidneys from heart-beating donors and 320 recipients of kidneys from non–heart-beating donors who died of cardiac arrest that occurred outside the hospital. One-year (about 90%) and 5-year (about 85%) graft survival rates were similar for transplantations from non–heart-beating donors and those from heart-beating donors who were younger than 60 years of age. Cautions This retrospective study is from a center with a well-developed non–heart-beating donor transplantation program. Implications People who die of cardiac arrest that occurs outside the hospital can be a viable source for kidney transplantations. —The Editors

 

Author and Article Information

From Hospital Clínico San Carlos, Universidad Complutense, and Servicio de Atención Municipal de Urgencias de Madrid, Madrid, Spain.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Ana I. Sánchez-Fructuoso, MD, PhD, Nephrology Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain; e-mail, sanchezfruct{at}telefonica.net.

Current Author Addresses: Drs. Sánchez-Fructuoso, Marques, Prats, Conesa, Calvo, and Barrientos: Nephrology Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

Dr. Pérez-Contín: Surgery Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

Dr. Blazquez: Urology Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

Dr. Fernández: Investigation Unit, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

Dr. Corral: SAMUR, Plaza de Legazpi s/n, 28010 Madrid, Spain.

Drs. Del Río and Núñez: Transplant Coordination, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

Author Contributions: Conception and design: A.I. Sánchez-Fructuoso.

Analysis and interpretation of the data: A.I. Sánchez-Fructuoso, A. Barrientos.

Drafting of the article: A.I. Sánchez-Fructuoso.

Critical revision of the article for important intellectual content: A.I. Sánchez-Fructuoso, A. Barrientos.

Final approval of the article: A.I. Sánchez-Fructuoso, M. Marques, D. Prats, J. Conesa, N. Calvo, M.J. Pérez-Contín, J. Blazquez, C. Fernández, E. Corral, F. Del Río, J.R. Núñez, A. Barrientos.

Provision of study materials or patients: A.I. Sánchez-Fructuoso, M. Marques, D. Prats, J. Conesa, N. Calvo, M.J. Pérez-Contín, J. Blazquez, C. Fernández, E. Corral, F. Del Río, J.R. Núñez, A. Barrientos.

Statistical expertise: A.I. Sánchez-Fructuoso, C. Fernández.

Administrative, technical, or logistic support: A.I. Sánchez-Fructuoso, N. Calvo, M.J Pérez-Contín.

Collection and assembly of data: N. Calvo.