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




Cyclosporin protocol
Cyclosporin protocol ‘The Thumper’)


Acute rejection rates
Acute rejection rates ‘The Thumper’)


Early graft function rates
Early graft function rates ‘The Thumper’)


Graft function
Graft function ‘The Thumper’)


Graft survival
Graft survival ‘The Thumper’)


Newcastle data km survival curves

With thanks to: ‘The Thumper’)

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


Newcastle data creatinine clearance cockroft gault
NEWCASTLE DATA: ‘The Thumper’)Creatinine Clearance (Cockroft & Gault)



Same case 3 months
Same case, 3 months ‘The Thumper’)

Hypertrophyof tubules

Little

fibrosis


Biopsy results a good case
Biopsy results: a ‘good’ case ‘The Thumper’)

1 week

1 month



1 week
1 week: ‘The Thumper’)


3 weeks
3 weeks: ‘The Thumper’)


2 months
2 months: ‘The Thumper’)



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: light)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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