Kokkinos C et al. (2007) Outcome of kidney transplantation from nonheart-beating versus heart-beating cadaveric donors. Transplantation 83: 1193–1199

A meta-analysis of studies that compared transplantation of kidneys from non-heartbeating (NHB) and heartbeating (HB) donors has been conducted. The results show that, although use of kidneys from NHB donors is associated with an increased incidence of adverse events in the short term, longer-term outcomes are comparable with those from HB donation.

The analysis included 18 retrospective studies published during the period 1992–2005, totaling 1,858 NHB donations (also known as 'donation after cardiac death' and 'asystolic donation'), and 112,223 HB donations from cadaveric donors. NHB kidneys had a significantly longer warm ischemia time than did HB kidneys (by 24 min; P <0.001). Cold ischemia times did not differ markedly. Transplantation of organs from NHB donors was associated with higher incidences of primary nonfunction and delayed function (P <0.001 for both), but not of acute rejection. Recipients of grafts from NHB donors also had a longer hospital stay (by 4.5 days; P <0.001).

The graft survival advantage observed in the HB group decreased as the studies progressed, however, and was nonsignificant at 10 years following transplantation. Interestingly, patient survival was higher in the NHB group during the initial postoperative period, but the difference was nonsignificant at 6 months and at all subsequent analysis points up to the end of follow-up (6 years).

This study indicates that NHB kidney donation could help to redress the current shortage of kidney donors; the authors believe that the elevated early risks of primary nonfunction and delayed graft function are offset by the promise of good long-term outcome.