Victims of Cardiac Arrest Occurring Outside the Hospital: A Source of Transplantable Kidneys

  1. Ana I. Sánchez-Fructuoso, MD, PhD;
  2. Maria Marques, MD, PhD;
  3. Dolores Prats, MD;
  4. José Conesa, MD;
  5. Natividad Calvo, MD;
  6. M. Jesús Pérez-Contín, MD;
  7. Jesús Blazquez, MD;
  8. Cristina Fernández, MD, PhD;
  9. Ervigio Corral, MD;
  10. Francisco Del Río, MD;
  11. Jose R. Núñez, MD, PhD; and
  12. Alberto Barrientos, MD, PhD
  1. From Hospital Clínico San Carlos, Universidad Complutense, and Servicio de Atención Municipal de Urgencias de Madrid, Madrid, Spain.

    Abstract

    Background: The use of non–heart-beating donors could help shorten the list of patients who are waiting for a kidney transplant. Several reports describe acceptable results of transplantations from non–heart-beating donors who had in-hospital cardiac arrest, but few reports describe results of transplantations from non–heart-beating donors who had cardiac arrest that occurred outside of the hospital (Maastricht type I and type II donors).

    Objective: To compare graft survival rates among patients receiving kidneys from heart-beating donors versus type I or type II non–heart-beating donors.

    Design: Retrospective cohort study of transplantations performed from January 1989 to December 2004.

    Setting: Kidney transplant program of a teaching hospital in Madrid, Spain.

    Patients: 320 patients who received a kidney transplant from non–heart-beating donors (273 type I donors and 47 type II donors) and 584 patients who received a kidney transplant from heart-beating donors divided into 2 groups according to donor age (age <60 years [n = 458] and age ≥60 years [n = 126]).

    Measurements: The primary outcome measure was graft survival. The median follow-up time was 68 months (range, 9 to 198 months).

    Results: One- and 5-year graft survival rates were 90.7% and 85.5%, respectively, for transplants from heart-beating donors younger than 60 years of age; 79.8% and 73.3%, respectively, for transplants from heart-beating donors 60 years of age or older (P < 0.001); and 87.4% and 82.1%, respectively, for transplants from non–heart-beating donors (P = 0.22 [vs. those from heart-beating donors < 60 years of age] and P = 0.014 [vs. those from heart-beating donors ≥ 60 years of age]). Graft survival did not differ between patients who received kidneys from heart-beating donors younger than 60 years of age and patients who received kidneys from non–heart-beating donors.

    Limitations: This single-site, observational study was retrospective, and immunosuppressive therapy regimens given to transplant recipients varied over time.

    Conclusions: Outcomes of transplants from non–heart-beating donors and younger heart-beating donors are similar, and results for transplants from non–heart-beating donors improved compared with those from older heart-beating donors. On the basis of these results, the authors encourage other transplant units to adopt the use of type I and type II non–heart-beating donors.

    Article and Author Information

    • Potential Financial Conflicts of Interest: None disclosed.

    • Requests for Single Reprints: Ana I. Sánchez-Fructuoso, MD, PhD, Nephrology Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain; e-mail, sanchezfruct{at}telefonica.net.

    • Current Author Addresses: Drs. Sánchez-Fructuoso, Marques, Prats, Conesa, Calvo, and Barrientos: Nephrology Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

    • Dr. Pérez-Contín: Surgery Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

    • Dr. Blazquez: Urology Department, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

    • Dr. Fernández: Investigation Unit, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

    • Dr. Corral: SAMUR, Plaza de Legazpi s/n, 28010 Madrid, Spain.

    • Drs. Del Río and Núñez: Transplant Coordination, Hospital Clínico San Carlos, Avenida Martín Lagos s/n, 28040 Madrid, Spain.

    • Author Contributions: Conception and design: A.I. Sánchez-Fructuoso.

    • Analysis and interpretation of the data: A.I. Sánchez-Fructuoso, A. Barrientos.

    • Drafting of the article: A.I. Sánchez-Fructuoso.

    • Critical revision of the article for important intellectual content: A.I. Sánchez-Fructuoso, A. Barrientos.

    • Final approval of the article: A.I. Sánchez-Fructuoso, M. Marques, D. Prats, J. Conesa, N. Calvo, M.J. Pérez-Contín, J. Blazquez, C. Fernández, E. Corral, F. Del Río, J.R. Núñez, A. Barrientos.

    • Provision of study materials or patients: A.I. Sánchez-Fructuoso, M. Marques, D. Prats, J. Conesa, N. Calvo, M.J. Pérez-Contín, J. Blazquez, C. Fernández, E. Corral, F. Del Río, J.R. Núñez, A. Barrientos.

    • Statistical expertise: A.I. Sánchez-Fructuoso, C. Fernández.

    • Administrative, technical, or logistic support: A.I. Sánchez-Fructuoso, N. Calvo, M.J Pérez-Contín.

    • Collection and assembly of data: N. Calvo.

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    1. Ann Intern Med August 1, 2006 vol. 145 no. 3 157-164
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