Non-heart-beating donor kidneys in The Netherlands: Allocation and outcome of transplantation

Background. Since February 1, 2001, kidneys from both heart-beating (HB) and non-heart-beating (NHB) donors in The Netherlands have been indiscriminately allocated through the standard renal-allocation system. Methods. Renal function and allograft-survival rate for kidneys from NHB and HB donors were compared at 3 and 12 months. Results. The outcomes of 276 renal transplants, 176 from HB donors and 100 from NHB III donors, allocated through the standard renal allocation system, Eurotransplant Kidney Allocation System, and performed between February 1, 2001 and March 1, 2002 were compared. Three months after transplantation, graft survival was 93.7% for HB kidneys and 85.0% for NHB kidneys (P < 0.05). At 12 months, graft survival was 92.0% and 83.0%, respectively (P < 0.03). Serum creatinine levels in the two groups were comparable at both 3 and 12 months. Multivariate analysis identified previous kidney transplantation (relative risk [RR] 3.133; P < 0.005), donor creatinine (RR 1.01; P < 0.005), and NHB (RR 2.38; P < 0.05) as independent risk factors for transplant failure within 12 months'. In multivariate analysis of NHB data, a warm ischemia time (WIT) of 30 minutes or longer (P < 0.005; RR 6.16, 95% confidence interval 2.11-18.00) was associated with early graft failure. No difference in 12-month graft survival was seen between HB and NHB kidneys after excluding the kidneys that failed in the first 3 months. Conclusion. Early graft failure was significantly more likely in recipients of kidneys from NHB donors. A prolonged WIT was strongly associated with this failure. Standard allocation procedures do not have a negative effect on outcome, and there is no reason to allocate NHB kidneys differently from HB kidneys.