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Renal transplantation from non-heart beating donors

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

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  1. 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

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

  7. Correct positioning of aortic catheter

  8. Cyclosporin protocol

  9. Acute rejection rates

  10. Early graft function rates

  11. Graft function

  12. Graft survival

  13. 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

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

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

  16. Same case, 3 months Hypertrophyof tubules Little fibrosis

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

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

  19. 1 week:

  20. 3 weeks:

  21. 2 months:

  22. Sirius Red analysis - fibrotic kidney

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

  24. 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

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