Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

Fabienne Fieux, Marie-Reine Losser, Eric Bourgeois, Francine Bonnet, Olivier Marie, François Gaudez, Imad Abboud, Jean-Luc Donay, France Roussin, François Mourey, Frédéric Adnet, Laurent Jacob, Fabienne Fieux, Marie-Reine Losser, Eric Bourgeois, Francine Bonnet, Olivier Marie, François Gaudez, Imad Abboud, Jean-Luc Donay, France Roussin, François Mourey, Frédéric Adnet, Laurent Jacob

Abstract

Introduction: To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed out-of-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors.

Methods: A prospective, monocentric, descriptive study concerning NHBD referred to our institution from February 2007 to June 2008. The protocol includes medical transport of refractory CA under mechanical ventilation and external cardiac massage, kidney protection by insertion of an intraaortic double-balloon catheter (DBC) with perfusion of a hypothermic solution, kidney retrieval and kidney preservation in a hypothermic pulsatile perfusion machine.

Results: 122 potential NHBD were referred to our institution after a mean resuscitation attempt of 35 minutes (20-95). Regarding the contraindications, 63 were finally accepted and 56 had the DBC inserted. Organ retrieval was performed in 27 patients (43%) and 31 kidneys out of the 54 procured (57%) have been transplanted. Kidney transplantation exclusion was related to family refusal (n = 15), past medical history, time constraints, viral serology, high vascular ex vivo resistance of the graft and macroscopic abnormalities. The 31 kidneys exhibited an expected high delayed graft function rate (92%). Despite these initial results transplanted kidney had good creatinine clearance at six months (66 +/- 24 ml/min) with a 89% graft survival rate at six months.

Conclusions: This study shows the feasibility and efficacy of an organ procurement program targeting NHBD allowing a 10% increase in the kidney transplantation rate over 17 months. With a six months follow-up period, the results of transplanted kidney function were excellent.

Figures

Figure 1
Figure 1
Protocol of care concerning non heart beating donors. Timings, exclusion criteria and protocol steps are described. The time between collapse and cardiopulmonary resuscitation (CPR) initiation had to be less than 30 minutes. The duration of CPR could not be less than 30 minutes. The time between collapse and intraaortic double balloon catheter (DBC) insertion had to be less than 150 minutes, defining warm ischaemia (WI). The time between DBC insertion and kidney retrieval had to be less than 180 minutes, while the kidney had to be transplanted within 18 hours after IGL-1 infusion initiation (cold ischaemia). HBV = hepatitis B virus; HCV = hepatitis C virus.
Figure 2
Figure 2
Study profile of non heart beating donors. DBC = double balloon catheter; NHBD = non heart beating donor.
Figure 3
Figure 3
Serum creatinine individual evolution in the NHBD kidney recipients transplanted in the authors' institution (n = 21). Steady state creatinine level was obtained on average three months after transplantation. NHBD = non heart beating donor.

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