1. 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

2. The problem - 1

3. The problem - 2

4. Sources of asystolic donors in Leicester
Irreversible cardiorespiratory arrest
Accident & Emergency department – failed resuscitation after MI
Medical wards – catastrophic intracerebral haemorrhage with ‘coning’

5. 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

6. A & E suture room

7. Mechanical cardiopulmonary resuscitation device (a.k.a. ‘The Thumper’)

9. Correct positioning of aortic catheter

10. Cyclosporin protocol

11. Acute rejection rates 32.6% 28.6% 46.9% 12.1% 5.2% 14.3% HBD N=224
NHBD
N=77 LD
N=49
Acute rejection
32.6%
28.6%
46.9%
Requiring ATG
12.1%
5.2%
14.3%

12. Early graft function rates
HBD
N=224
NHBD
N=77 LD
N=49
Primary non-function
2.7%
9.1% 2%
Delayed graft function
21.0%
84.4%
4.1%
Initial function
76.3%
6.5%
93.9%

13. Graft function

14. Graft survival

15. 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

16. NEWCASTLE DATA: Creatinine Clearance (Cockroft & Gault)

17. Biopsy results: a ‘typical’ case, 1 week

18. Same case, 3 months
Hypertrophy of tubules
Little
fibrosis

19. Biopsy results: a ‘good’ case
1 week
1 month

20. Biopsy results: a ‘bad’ case. Pre-perfusion:

21. 1 week:

22. 3 weeks:

23. 2 months:

24. Sirius Red analysis - normal kidney

25. Sirius Red analysis - fibrotic kidney

26. Interstitial collagen volume fraction (Sirius Red, polarized light) Conventional and NHBD kidneys, 6 month protocol biopsies %
P<0.05

27. 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