renal transplantation from non heart beating donors
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Renal transplantation from non-heart beating donors. M L Nicholson P N Furness* Departments of Transplant Surgery and *Pathology Leicester General Hospital UK. The University of Leicester. The problem - 1. The problem - 2. Sources of asystolic donors in Leicester.

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renal transplantation from non heart beating donors

Renal transplantation fromnon-heart beating donors

M L Nicholson

P N Furness*

Departments of Transplant Surgery and *Pathology

Leicester General Hospital

UK

The University of Leicester

sources of asystolic donors in leicester
Sources of asystolic donors in Leicester
  • Irreversible cardiorespiratory arrest
  • Accident & Emergency department –failed resuscitation after MI
  • Medical wards –catastrophic intracerebral haemorrhage with ‘coning’
leicester selection criteria for nhbds
Leicester selection criteria for NHBDs
  • Age<60
  • Warm ischaemic time <40 minutes
  • No history of renal impairment
  • No uncontrolled hypertension
  • No complicated insulin dependent diabetes
  • No systemic sepsis or malignancy
newcastle data km survival curves

With thanks to:

Gok MA

Buckley PE

Mohamed MAS

Balupuri S

Shenton BK

Robertson H

Soomro N

Manas D

Talbot D

Liver / Renal Transplant Unit, The Freeman Hospital, Newcastle Upon Tyne,

UK

NEWCASTLE DATA: KM - Survival curves
same case 3 months
Same case, 3 months

Hypertrophyof tubules

Little

fibrosis

slide24
Interstitial collagen volume fraction (Sirius Red, polarized light)Conventional and NHBD kidneys, 6 month protocol biopsies

%

P<0.05

conclusions non heart beating donor kidneys
Conclusions: Non-heart beating donor kidneys
  • Increased PNF rate (decreases with experience)
  • High DGF rate; dialysis usually needed
  • Slightly higher serum creatinine, may compensate
  • Slightly more interstitial fibrosis at 6 months
  • Indistinguishable graft survival rate at 5 years
  • Biopsy does not help with donor selection (?)
  • Protocol biopsies detect acute rejection at unchanged rate
  • Biopsy helps to distinguish PNF and DGF, but care needed
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