Outcome of machine-perfused non-heart-beating donor kidneys, not allocated within the Eurotransplant area

Abstract

Eleven non-heart-beating (NHB) donor kidneys considered vital during machine perfusion (MP), could not be allocated inside Eurotransplant (ET). With the help of ET, five kidneys were transplanted in Karachi and six in Basel. Our goal was to prove that NHB kidneys successfully passing MP viability tests can be transplanted safely. Methods: Donor age, serum creatinine (some post-mortem) and warm ischaemic time were, respectively, (mean and range): 44 (14-70) years, 137 μmol/l, and 44 (9-80) min. Reasons for refusal were: bold ureter (one), suboptimal flush (one), relatively long hypotensive phase (seven), and donor age of 70 years (two). After 8 h of MP, mean lactate dehydrogenase, intrarenal resistance and alpha glutathione S-transferase were (including range): 556 U/l (range 366-819 U/l), 0.86 mmHg/ml per min (0.41-1.15 mmHg/ml per min) and 1188 μg/l (575-2677 μg/l), respectively. Mean cold ischaemic time was 45 (range 28-72) h. Results: Two kidneys showed immediate function, and nine showed delayed function. Mean creatinine levels after 1, 3 and 6 months were 295, 200 and 206 μmol/l, respectively. Four patients died for reasons not related to their kidney transplantation. Conclusions: We claim that MP can successfully assess viability of NHB donor kidneys. The reluctance to accept MP, and judged vital, NHB donor kidneys is no longer justified. © Springer-Verlag 1998.