• Ana I Sánchez-Fructuoso, Maria Marques, Dolores Prats, José Conesa, Natividad Calvo, M Jesús Pérez-Contín, Jesús Blazquez, Cristina Fernández, Ervigio Corral, Francisco Del Río, Jose R Núñez, and Alberto Barrientos.
• Hospital Clínico San Carlos, Universidad Complutense, and Servicio de Atención Municipal de Urgencias de Madrid, Madrid, Spain. sanchezfruct@telefonica.net
• Ann. Intern. Med. 2006 Aug 1;145(3):157-64.

BackgroundThe 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).ObjectiveTo compare graft survival rates among patients receiving kidneys from heart-beating donors versus type I or type II non-heart-beating donors.DesignRetrospective cohort study of transplantations performed from January 1989 to December 2004.SettingKidney transplant program of a teaching hospital in Madrid, Spain.Patients320 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 > or =60 years [n = 126]).MeasurementsThe primary outcome measure was graft survival. The median follow-up time was 68 months (range, 9 to 198 months).ResultsOne- 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 >or = 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.LimitationsThis single-site, observational study was retrospective, and immunosuppressive therapy regimens given to transplant recipients varied over time.ConclusionsOutcomes 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.

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