Renal transplantations performed using non-heartbeating organ donors: Going back to the future?

Steven M. Rudich, Bruce Kaplan, John C. Magee, Juan D. Arenas, Jeffrey D. Punch, Liise K. Kayler, Robert M. Merion, Herwig Ulf Meier-Kriesche

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

Background. As more expanded-criteria organ donors are used to bridge the widening gap between organ supply and demand, non-heart-beating (NHB) donors will become increasingly important. The purpose of this study was to analyze renal transplant outcomes using this source of cadaveric (CAD) organs and compare the results with heart-beating organ sources. Methods. Data from 98,698 adult CAD renal transplant recipients and 34,531 living donor renal transplant recipients registered in the U. S. Renal Data System database between January 1993 and June 2000 were analyzed. Kaplan-Meier survival curves were used to compare graft and patient survival rates between NHB, CAD, and living donor transplant recipients. Cox proportional hazards models were used to identify risk factors for NHB donor recipients, while adjusting for potential confounding variables. Results. Recipients of NHB donor organs experienced nearly twice the incidence of delayed graft function (DGF) compared with heart-beating donors (42.4% vs. 23.3%, respectively). NHB donor transplants experienced comparable allograft survival when compared with CAD transplants at 6 years (73.2% vs. 72.5%, respectively; P=NS); patient survival was greater at 6 years for NHB compared with CAD renal transplant recipients (80.9% vs. 77.8%, respectively; P=NS). Significant factors for allograft loss for NHB donor organ recipients included the following: organ used for repeat transplants; DGF; donor age older than 35 years; and head trauma as a cause of initial injury (relative risk 2.74, 1.90, 1.78, and 1.41, respectively). Conclusions. Although exhibiting elevated DGF rates, allograft and patient survival rates of transplants from NHB donor sources are equivalent to those from conventional CAD sources. Donor age, recipient transplant number, female recipient, mechanism of injury, and DGF were the most pertinent variables leading to poor outcomes.

Original languageEnglish (US)
Pages (from-to)1715-1720
Number of pages6
JournalTransplantation
Volume74
Issue number12
StatePublished - Dec 27 2002
Externally publishedYes

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Kidney Transplantation
Tissue Donors
Delayed Graft Function
Kidney
Allografts
Transplants
Living Donors
Survival Rate
Confounding Factors (Epidemiology)
Wounds and Injuries
Kaplan-Meier Estimate
Graft Survival
Craniocerebral Trauma
Proportional Hazards Models
Information Systems
Transplant Recipients
Databases
Survival
Incidence

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Rudich, S. M., Kaplan, B., Magee, J. C., Arenas, J. D., Punch, J. D., Kayler, L. K., ... Meier-Kriesche, H. U. (2002). Renal transplantations performed using non-heartbeating organ donors: Going back to the future? Transplantation, 74(12), 1715-1720.

Renal transplantations performed using non-heartbeating organ donors : Going back to the future? / Rudich, Steven M.; Kaplan, Bruce; Magee, John C.; Arenas, Juan D.; Punch, Jeffrey D.; Kayler, Liise K.; Merion, Robert M.; Meier-Kriesche, Herwig Ulf.

In: Transplantation, Vol. 74, No. 12, 27.12.2002, p. 1715-1720.

Research output: Contribution to journalArticle

Rudich, SM, Kaplan, B, Magee, JC, Arenas, JD, Punch, JD, Kayler, LK, Merion, RM & Meier-Kriesche, HU 2002, 'Renal transplantations performed using non-heartbeating organ donors: Going back to the future?', Transplantation, vol. 74, no. 12, pp. 1715-1720.
Rudich SM, Kaplan B, Magee JC, Arenas JD, Punch JD, Kayler LK et al. Renal transplantations performed using non-heartbeating organ donors: Going back to the future? Transplantation. 2002 Dec 27;74(12):1715-1720.
Rudich, Steven M. ; Kaplan, Bruce ; Magee, John C. ; Arenas, Juan D. ; Punch, Jeffrey D. ; Kayler, Liise K. ; Merion, Robert M. ; Meier-Kriesche, Herwig Ulf. / Renal transplantations performed using non-heartbeating organ donors : Going back to the future?. In: Transplantation. 2002 ; Vol. 74, No. 12. pp. 1715-1720.
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title = "Renal transplantations performed using non-heartbeating organ donors: Going back to the future?",
abstract = "Background. As more expanded-criteria organ donors are used to bridge the widening gap between organ supply and demand, non-heart-beating (NHB) donors will become increasingly important. The purpose of this study was to analyze renal transplant outcomes using this source of cadaveric (CAD) organs and compare the results with heart-beating organ sources. Methods. Data from 98,698 adult CAD renal transplant recipients and 34,531 living donor renal transplant recipients registered in the U. S. Renal Data System database between January 1993 and June 2000 were analyzed. Kaplan-Meier survival curves were used to compare graft and patient survival rates between NHB, CAD, and living donor transplant recipients. Cox proportional hazards models were used to identify risk factors for NHB donor recipients, while adjusting for potential confounding variables. Results. Recipients of NHB donor organs experienced nearly twice the incidence of delayed graft function (DGF) compared with heart-beating donors (42.4{\%} vs. 23.3{\%}, respectively). NHB donor transplants experienced comparable allograft survival when compared with CAD transplants at 6 years (73.2{\%} vs. 72.5{\%}, respectively; P=NS); patient survival was greater at 6 years for NHB compared with CAD renal transplant recipients (80.9{\%} vs. 77.8{\%}, respectively; P=NS). Significant factors for allograft loss for NHB donor organ recipients included the following: organ used for repeat transplants; DGF; donor age older than 35 years; and head trauma as a cause of initial injury (relative risk 2.74, 1.90, 1.78, and 1.41, respectively). Conclusions. Although exhibiting elevated DGF rates, allograft and patient survival rates of transplants from NHB donor sources are equivalent to those from conventional CAD sources. Donor age, recipient transplant number, female recipient, mechanism of injury, and DGF were the most pertinent variables leading to poor outcomes.",
author = "Rudich, {Steven M.} and Bruce Kaplan and Magee, {John C.} and Arenas, {Juan D.} and Punch, {Jeffrey D.} and Kayler, {Liise K.} and Merion, {Robert M.} and Meier-Kriesche, {Herwig Ulf}",
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T1 - Renal transplantations performed using non-heartbeating organ donors

T2 - Going back to the future?

AU - Rudich, Steven M.

AU - Kaplan, Bruce

AU - Magee, John C.

AU - Arenas, Juan D.

AU - Punch, Jeffrey D.

AU - Kayler, Liise K.

AU - Merion, Robert M.

AU - Meier-Kriesche, Herwig Ulf

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Y1 - 2002/12/27

N2 - Background. As more expanded-criteria organ donors are used to bridge the widening gap between organ supply and demand, non-heart-beating (NHB) donors will become increasingly important. The purpose of this study was to analyze renal transplant outcomes using this source of cadaveric (CAD) organs and compare the results with heart-beating organ sources. Methods. Data from 98,698 adult CAD renal transplant recipients and 34,531 living donor renal transplant recipients registered in the U. S. Renal Data System database between January 1993 and June 2000 were analyzed. Kaplan-Meier survival curves were used to compare graft and patient survival rates between NHB, CAD, and living donor transplant recipients. Cox proportional hazards models were used to identify risk factors for NHB donor recipients, while adjusting for potential confounding variables. Results. Recipients of NHB donor organs experienced nearly twice the incidence of delayed graft function (DGF) compared with heart-beating donors (42.4% vs. 23.3%, respectively). NHB donor transplants experienced comparable allograft survival when compared with CAD transplants at 6 years (73.2% vs. 72.5%, respectively; P=NS); patient survival was greater at 6 years for NHB compared with CAD renal transplant recipients (80.9% vs. 77.8%, respectively; P=NS). Significant factors for allograft loss for NHB donor organ recipients included the following: organ used for repeat transplants; DGF; donor age older than 35 years; and head trauma as a cause of initial injury (relative risk 2.74, 1.90, 1.78, and 1.41, respectively). Conclusions. Although exhibiting elevated DGF rates, allograft and patient survival rates of transplants from NHB donor sources are equivalent to those from conventional CAD sources. Donor age, recipient transplant number, female recipient, mechanism of injury, and DGF were the most pertinent variables leading to poor outcomes.

AB - Background. As more expanded-criteria organ donors are used to bridge the widening gap between organ supply and demand, non-heart-beating (NHB) donors will become increasingly important. The purpose of this study was to analyze renal transplant outcomes using this source of cadaveric (CAD) organs and compare the results with heart-beating organ sources. Methods. Data from 98,698 adult CAD renal transplant recipients and 34,531 living donor renal transplant recipients registered in the U. S. Renal Data System database between January 1993 and June 2000 were analyzed. Kaplan-Meier survival curves were used to compare graft and patient survival rates between NHB, CAD, and living donor transplant recipients. Cox proportional hazards models were used to identify risk factors for NHB donor recipients, while adjusting for potential confounding variables. Results. Recipients of NHB donor organs experienced nearly twice the incidence of delayed graft function (DGF) compared with heart-beating donors (42.4% vs. 23.3%, respectively). NHB donor transplants experienced comparable allograft survival when compared with CAD transplants at 6 years (73.2% vs. 72.5%, respectively; P=NS); patient survival was greater at 6 years for NHB compared with CAD renal transplant recipients (80.9% vs. 77.8%, respectively; P=NS). Significant factors for allograft loss for NHB donor organ recipients included the following: organ used for repeat transplants; DGF; donor age older than 35 years; and head trauma as a cause of initial injury (relative risk 2.74, 1.90, 1.78, and 1.41, respectively). Conclusions. Although exhibiting elevated DGF rates, allograft and patient survival rates of transplants from NHB donor sources are equivalent to those from conventional CAD sources. Donor age, recipient transplant number, female recipient, mechanism of injury, and DGF were the most pertinent variables leading to poor outcomes.

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