Original Article
Kidney Transplantation from Donors without a Heartbeat
N Engl J Med 2002; 347:248-255July 25, 2002
- Abstract
Background
The dramatic shortage of kidney donors has triggered interest in other sources of organs, such as donors without a heartbeat. Accumulating evidence suggests that the short-term survival of cadaveric kidneys from such donors is similar to that of cadaveric kidneys from donors with a heartbeat. However, no data from large, matched studies with long-term follow-up are available. We conducted a matched, single-center study of kidney transplants obtained from donors without a heartbeat and those from donors with a heartbeat, with a 15-year follow-up period.
Methods
Between 1985 and 2000, 122 kidney transplantations involving donors without a heartbeat were performed at the University of Zurich, in Switzerland. Outcomes of these procedures were compared with those of 122 transplantations of kidneys from donors with a heartbeat. The recipients were matched according to age, sex, number of transplantations, and calendar period of transplantation.
Results
The characteristics of the recipients did not differ significantly between the two groups. We observed a significantly higher incidence of delayed graft function among the patients who received kidneys from donors without a heartbeat (48.4 percent) than among the patients who received kidneys from donors with a heartbeat (23.8 percent) (P<0.001). However, the long-term rate of graft survival was similar in the two groups (P=0.98): at 10 years, the rate of graft survival was 78.7 percent for kidneys from donors without a heartbeat and 76.7 percent for kidneys from donors with a heartbeat.
Conclusions
Although the incidence of delayed graft function is significantly higher with kidneys from donors without a heartbeat than with kidneys from donors with a heartbeat, there is no difference in long-term outcome between the two types of graft.
Media in This Article
Figure 1
Rates of Long-Term Graft Survival after Transplantation of Kidneys from Donors without a Heartbeat and Donors with a Heartbeat.Table 1
Studies of Kidney Transplantation from Donors without a Heartbeat.Article Activity
- Article
The number of patients awaiting organs for transplantation has grown dramatically during the past two decades, triggering interest in expanding the pool of organs beyond those obtained from brain-dead donors with a heartbeat. Alternative sources of organs include elderly, brain-dead donors whose hearts continue to beat, living donors, and donors without a heartbeat. A successful program of transplantation from donors without a heartbeat could increase the number of kidneys available for transplantation by 30 percent.1
Death in donors without a heartbeat is defined as an irreversible cessation of circulatory and respiratory function,2 whereas brain death in donors with a heartbeat is determined according to neurologic criteria. Therefore, by definition, a donor without a heartbeat has had a prolonged phase of hypotension (one that lasts several minutes) followed by cardiac arrest before organ harvesting. Insufficient perfusion or complete lack of perfusion of such organs has long been thought to cause irreversible damage, resulting in poor short-term and long-term outcomes after grafting.3 With the exception of recent limited experience in liver transplantation,4 the use of organs from donors without a heartbeat has been restricted to the kidneys, since dialysis is available for support in case the graft does not function after transplantation.
Data regarding the use of organs from donors without a heartbeat have remained scarce; data from several centers are often pooled to achieve relevant numbers (Table 1Table 1
Studies of Kidney Transplantation from Donors without a Heartbeat.). None of the studies conducted so far have provided long-term follow-up data, and only a few have reported results more than five years after transplantation. In addition, some studies have not included comparison groups (e.g., matched groups of patients receiving grafts from donors with a heartbeat). Thus, the controversy surrounding the outcomes of kidney transplants from donors without a heartbeat has remained unsettled. In 1985, the University Hospital Zurich (Zurich, Switzerland) initiated a kidney-transplantation program involving the use of grafts from donors without a heartbeat. This program continues to operate and uses a well-established protocol. In the current study, we compared the results of the entire series of 122 patients in the Zurich program with the results from a group of 122 matched patients who received grafts from donors with a heartbeat.Methods
Of 1133 kidneys transplanted at our institution between January 1985 and March 2000, 122 (10.8 percent) were obtained from donors without a heartbeat. From our data base of recipients of kidneys from donors with a heartbeat, 122 randomly identified patients were matched on a one-to-one basis with the patients. Data were collected prospectively during routine follow-up at our institution, and complete follow-up information was available for each patient.
Institutional approval was obtained in accordance with the guidelines of the Swiss Academy of Medical Sciences. Potential recipients of a kidney graft were informed at the time of their acceptance for the waiting list that they might receive an organ from an alternative donor, such as an elderly donor or a donor without a heartbeat, in order to reduce waiting time. With regard to consent from the family of the donor, legislation allowing presumed consent has been enacted in the state of Zurich. Therefore, until 1995, when the Maastricht protocol was established, a few organs from donors without a heartbeat were procured, with presumed consent. Since then, informed consent has routinely been obtained from every donor's next of kin.
Donors and Recipients
A standardized protocol for the transplantation of kidneys from donors without a heartbeat has been used at our institution since this transplantation program was initiated, in 1985. Our initial protocol was similar to the Maastricht protocol (Table 2Table 2
Key Points of the Maastricht Protocol Regarding the Use of Organs from Donors without a Heartbeat.),14 established in 1995, with the exception of the waiting period after cardiac arrest. During the first decade of the study, from 1985 until 1995, organ retrieval was initiated 5 minutes after cardiopulmonary arrest; after 1995, organ retrieval was performed according to the Maastricht protocol, which requires a waiting period of 10 minutes after cardiopulmonary arrest. All 122 kidney donors who had a heartbeat fulfilled the criteria for brain death.To conduct this matched-pair study, we randomly matched each recipient of a kidney graft from a donor without a heartbeat to a patient from our data base of recipients of kidneys from donors with a heartbeat. The two groups of recipients were matched according to sex, age (within 5 years), and the calendar period of transplantation (within 12 months).
All recipients were chosen according to our local allocation system, which considers HLA matching, age matching, and recipients' waiting time. Beginning in 1989, only primary transplantations were performed with organs from donors without a heartbeat, because of the failure of two such grafts in patients who underwent transplantation at the beginning of the program. The recipients of grafts from donors with a beating heart were treated with standard triple-immunosuppressive therapy consisting of prednisone, cyclosporine (Sandimmune, Novartis), and azathioprine (Imurek, Wellcome); azathioprine was replaced by mycophenolate mofetil (CellCept, Roche) in patients who underwent transplantation after 1996. In the recipients of grafts from donors without a heartbeat, immunosuppression was induced with intravenous antithymocyte globulin (ATG, Fresenius), with overlapping therapy consisting of oral cyclosporine beginning 10 days after surgery.15 Except for the use of antithymocyte globulin in the latter group, the immunosuppressive regimen in the two groups was identical.
Delayed graft function was defined as the need for dialysis during the first week after transplantation, with subsequent recovery of renal function. Primary nonfunction was defined as the absence of renal function during follow-up. When the initial function of the graft was impaired, surveillance biopsy was performed weekly to permit detection of acute episodes of rejection.16 Each episode of acute rejection during a period of delayed graft function was confirmed by biopsy and was graded according to the Banff criteria.17
Data Collection and Statistical Analysis
Data were prospectively collected and stored in a data base. Patients who died were considered either to have had a failed graft or (in the case of those who died of other causes) to have had a functioning graft. Graft survival was recorded for all the patients, including those who died with a functioning graft. In some analyses, data on patients who died with a functioning graft were censored.
To evaluate the natural course of the transplanted grafts, we conducted analyses that included patients whose data were censored after they died with a functioning graft, unless otherwise indicated. Categorical variables were analyzed with the use of the chi-square test or, when appropriate, Fisher's exact test. Continuous variables were analyzed with the use of the Mann–Whitney U test; the results are expressed as means ±SD, unless otherwise stated. Rates of graft survival were computed by the Kaplan–Meier method, and comparisons among groups were calculated with the use of the log-rank test. A P value of less than 0.05 was considered to indicate statistical significance. Variables that were significant in the univariate analysis were included in a Cox proportional-hazards analysis performed to identify independent risk factors for graft failure.
Results
Characteristics of the Donors and Recipients
The characteristics of the donors without a heartbeat and of those with a heartbeat were not significantly different except with respect to the cause of death, the duration of warm ischemia, and the use of diuresis in the hour before organ harvesting (Table 3Table 3
Characteristics of the Donors and Recipients.). The distribution of the 122 donors without a heartbeat according to the categories in the Maastricht protocol14 was as follows. In no case was an organ procured from a donor who was dead on arrival at the hospital (Maastricht protocol category I). In the case of 56 donors (46 percent), resuscitation after cardiac arrest was unsuccessful (category II). In these 56 cases, resuscitation efforts had been performed for a minimum of 30 minutes, in accordance with the guidelines of the Swiss Academy of Medical Sciences. Cardiac arrest was awaited in 57 patients (47 percent) (category III), and cardiac arrest occurred before brain death could be diagnosed in 9 (7 percent) (category IV). For donors in category III, the decision to continue life-support measures was made by physicians who acted strictly independently of the transplantation team. The mean hospitalization time from admission until organ procurement was 28.1±26.4 hours for the “controlled” donations (involving donors in category III or IV) and 5.4±3.0 hours for the “uncontrolled” donations (involving donors in category I or II).The characteristics of the recipients (including age, sex, number of previous transplantations, and 12-month period of transplantation) did not differ between those who received kidneys from donors without a heartbeat and those who received kidneys from donors with a heartbeat. The number of immunologically sensitized patients with panel-reactive antibody values greater than 50 percent was also similar in these two groups. Likewise, variables for which the two groups were not matched, such as the duration of dialysis before transplantation, the type of dialysis (hemodialysis or continuous ambulatory peritoneal dialysis), and the average number of HLA mismatches, were also not significantly different in the two groups (Table 3).
Outcomes of the Grafts
Primary nonfunction occurred in both groups; the incidence was 5.7 percent among the kidneys from donors without a heartbeat and 4.9 percent among those from donors with a heartbeat (P=0.99) (Table 4Table 4
Outcomes after Transplantation.). Delayed graft function occurred more frequently with the kidneys from donors without a heartbeat than with those from donors with a heartbeat (48.4 percent vs. 23.8 percent, P<0.001). The higher incidence of delayed graft function in the former group was reflected in their higher serum creatinine levels on postoperative day 7 (4.0 mg per deciliter [354 μmol per liter] vs. 2.6 mg per deciliter [230 μmol per liter], P<0.001). However, the serum creatinine levels among patients with a functioning graft were similar in the two groups at one month (1.8 mg per deciliter [159 μmol per liter] in both groups, P=0.90) and at one year (1.5 mg per deciliter [133 μmol per liter] and 1.6 mg per deciliter [141 μmol per liter] in those with a graft from a donor without a heartbeat and those with a graft from a donor with a heartbeat, respectively; P=0.11).The median follow-up for the analysis of graft survival was 8.7 years (range, 1.4 to 15.2). Thirteen of the 122 patients in each group (10.7 percent) died with a functioning graft during follow-up. There was no significant difference in the rate of graft survival between kidneys from donors without a heartbeat and those from donors with a heartbeat one year after transplantation (91.6 percent and 90.6 percent, respectively) (Figure 1Figure 1
Rates of Long-Term Graft Survival after Transplantation of Kidneys from Donors without a Heartbeat and Donors with a Heartbeat.). The rates of graft survival calculated 5 and 10 years after transplantation were 83.7 percent and 78.8 percent, respectively, in patients who received kidneys from donors without a heartbeat and 82.3 percent and 76.7 percent, respectively, in those who received kidneys from donors with a heartbeat (P=0.98 by Kaplan–Meier survival analysis) (Figure 1A). In an analysis of the patients whose data were not censored because of death with a functioning graft, the long-term graft survival was found to be similar in the two groups (P=0.92) (Figure 1B).Univariate analysis with the log-rank test revealed that delayed graft function had a significant adverse effect on the survival of grafts from donors with a heartbeat (P=0.006 for the comparison with grafts without delayed function), whereas this effect was not noted in the grafts from donors without a heartbeat (P=0.15). According to the univariate analysis, significant risk factors for graft loss among the patients in the latter group were a panel-reactive antibody value above 50 percent (P=0.028 for the comparison with a value ≤50 percent), acute rejection (P=0.01 for the comparison with the absence of such rejection), and corticosteroid-resistant rejection (P=0.006 for the comparison with the absence of such rejection). Acute rejection was also a risk factor for the loss of grafts from donors with a heartbeat (P=0.029 for the comparison with grafts not affected by acute rejection). The following variables had no significant influence on graft survival in either group: trauma or cerebrovascular disease as the cause of death in the donor, the age of the donor (range, 4 to 73 years among those with a heartbeat and 15 to 61 years among those without a heartbeat), diuresis during the hour before death, the age of the recipient (range, 12 to 71 years among those who received a graft from a donor without a heartbeat and 14 to 75 years among those who received a graft from a donor with a heartbeat), sex, and number of HLA mismatches. The duration of cold ischemia did not correlate with graft outcome in either group (grafts from donors without a heartbeat: mean, 17 hours; range, 4 to 35; P=0.47 for the comparison between long [>24 hours] and short periods of cold ischemia; grafts from donors with a heartbeat: mean, 15 hours; range, 3 to 30; P=0.97). The duration of warm ischemia among the grafts from donors without a heartbeat (29±9 minutes; range, 10 to 60) had no significant effect on the survival of the grafts (P=0.56 for the comparison between long [>30 minutes] and short periods of warm ischemia). Finally, the survival of grafts from donors without a heartbeat was not significantly influenced by the Maastricht protocol category14 of the donation (“controlled” or “uncontrolled,” P=0.69).
The multivariate analysis conducted to identify independent risk factors revealed a strong and significant association between delayed graft function and decreased graft survival in the grafts that had been obtained from donors with a heartbeat (P=0.03 for the comparison between grafts with delayed function and those without delayed function) but not among the grafts from donors without a heartbeat (P=0.28). In the latter group, risk factors for graft failure that reached statistical significance in the Cox regression analysis were panel-reactive antibody values above 50 percent (P=0.03 for the comparison with values ≤50 percent) and episodes of corticosteroid-resistant rejection (P<0.001 for the comparison with the absence of such episodes) (Table 5Table 5
Risk Factors for Graft Failure, According to the Cox Regression Analysis.).Discussion
In this single-center, matched-pair study, we found that although the incidence of delayed graft function affecting kidneys from donors without a heartbeat was approximately double that affecting kidneys from donors with a heartbeat, the two groups had similar, low rates of primary nonfunction and similar long-term outcomes. These data support the concept that kidneys from donors without a heartbeat can routinely be included in kidney-transplantation programs, thus decreasing waiting times and mortality rates among patients who are waiting for organs.18
The numbers of patients awaiting organs and the waiting periods before transplantation have increased dramatically during the past decade.19 This situation has triggered interest in seeking alternative strategies for enlarging the donor pool — for example, by retrieving organs from living unrelated donors, elderly brain-dead donors, or donors without a heartbeat. Validation of these alternative approaches is critical if they are to be appropriately recommended by those who make transplantation policy.
Despite its introduction into clinical practice in the early 1980s, the use of organs from donors without a heartbeat has not been popular.20 Numerous issues of concern have been raised about this type of donation, with medical and ethical issues central among them. The poor long-term survival expected of such grafts as a consequence of the high incidence of delayed graft function has been mentioned repeatedly.21,22 The controversy has been sustained by opposing voices that suggest good outcomes with grafts from donors without a heartbeat (Table 1). The absence of properly designed studies with long-term follow-up, particularly the lack of appropriate comparison groups of patients, has prevented the discussion about this type of donation from moving beyond speculation. In addition, multicenter analyses of transplantation programs that make use of organs from donors without a heartbeat suffer from “center effects,” since policies regarding the medical and ethical management of donors without a heartbeat vary among institutions and have varied over time.23
The present study is based on the experience at a single center and extends the analysis of outcome beyond a 10-year follow-up period. A standard protocol was used for all the transplantations, and follow-up was complete for all the donors and recipients. Since a randomized trial was not feasible, a matched-pair design using a large data base of patients who received kidneys from donors with a heartbeat at the same center seemed appropriate. As in previous reports,1,12 delayed graft function was more frequent among the recipients of grafts from donors without a heartbeat than among other recipients. However, delayed graft function had no significant negative effect on long-term organ survival in the former group. These results are in contrast to the negative effects of delayed function on graft survival in the recipients of kidneys from donors with a heartbeat. These negative effects have been noted in several other series.24-26
In patients with anuria who have delayed graft function, episodes of rejection may be missed because there is a lack of clinical monitoring. Therefore, our protocol included routine biopsy of nonfunctional renal grafts both from donors with a heartbeat and donors without a heartbeat so that rejection would not be missed and left untreated.27 This approach is particularly crucial for recipients of grafts from donors without a heartbeat, since the incidence of delayed graft function is higher in this group than in recipients of grafts from donors with a heartbeat. We also used a distinct protocol for the induction of immunosuppression in patients who received renal transplants from donors without a heartbeat. Because of the nephrotoxic effects of cyclosporine, we used antithymocyte globulin for the first 10 days after transplantation in these patients, so as to avoid additional damage to the transplanted kidney. The decision not to use macrolides such as cyclosporine or tacrolimus for the induction of immunosuppression in these patients is further supported by the recent suggestion that the nephrotoxic effect of these drugs is augmented by coexisting ischemic injury.28 In contrast, antithymocyte globulin contains antibodies to many proinflammatory molecules and may therefore contribute to the attenuation of ischemia–reperfusion injury29 — a property that might be particularly important in the transplantation of organs from donors without a heartbeat.
The type of donor — either controlled or uncontrolled, as defined by the Maastricht protocol14 — has been reported to be a crucial variable affecting the survival of grafts from donors without a heartbeat.1 However, this variable did not influence the outcome of kidney transplantation from donors without a heartbeat in our study. The duration of warm ischemia in our cohort was less than 60 minutes, indicating that uncontrolled donors without a heartbeat who have a short warm-ischemia time can be a useful source of grafts. The cause of the donor's death and the donor's and recipient's ages also had no significant influence on long-term graft survival in our study, in contrast to previous studies.12 Previous recommendations for limiting the use of organs from donors without a heartbeat should be reconsidered.
In situ cooling of the kidneys by intraaortic infusion of cold preservation solution, as performed by many investigators,8,10 was not included in our protocol of organ harvesting. In situ cooling is often started before the consent of the potential donor's family has been obtained. This practice has triggered serious ethical debate,20 rendering the use of organs from donors without a heartbeat unpopular and often unacceptable. Our study shows that excellent results can be obtained without the use of this questionable technique. We also show that a waiting time of 10 minutes after cardiopulmonary arrest, as proposed in the Maastricht protocol,14 does not appear to influence the long-term survival of kidneys from donors without a heartbeat. If these points are considered, ethical concerns regarding the use of grafts from donors without a heartbeat may diminish, and our results may provide a new basis for the reevaluation of this source of organs by transplantation centers and by legislative bodies that have thus far proscribed the use of organs from donors without a heartbeat.
We are indebted to Dr. Burkhardt Seifert (Division of Biostatistics, University of Zurich) for the statistical analyses and to Dr. Ueli Binswanger, Dr. Reto Stocker, Dr. Daniel Candinas, Dr. Rolf Schlumpf, Dr. Marco Decurtins, Julia Hofmann, and Petra Seeburger for important contributions. This article is dedicated to Felix Largiader, who pioneered organ transplantation in Switzerland and who initiated this program in Zurich in 1985.
Source Information
From the Department of Visceral Surgery and Transplantation (M.W., D.D., N.D., P.-A.C.) and the Division of Nephrology (P.M.A.), University Hospital Zurich, Zurich, Switzerland.
Address reprint requests to Dr. Clavien at the Department of Surgery, University Hospital Zurich, Ramistr. 100, CH-8091 Zurich, Switzerland, or at clavien@chir.unizh.ch.
- References
References
1
Sanchez-Fructuoso AI ,Prats D ,Torrente J , et al. Renal transplantation from non-heart beating donors: a promising alternative to enlarge the donor pool. J Am Soc Nephrol 2000;11:350-358
Web of Science | Medline2
Guidelines for the determination of death: report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA 1981;246:2184-2186
CrossRef | Web of Science3
Kahan BD, Ponticelli C. Selection and operative approaches for donors: non-heart-beating cadaveric donors. In: Kahan BD, Ponticelli C, eds. Principles and practice of renal transplantation. London: Martin Dunitz, 2000:149-50.
4
D'allessandro AM ,Hoffman RM ,Knechtle SJ , et al. Liver transplantation from controlled non-heart-beating donors. Surgery 2000;128:579-588
CrossRef | Web of Science | Medline5
Wijnen RMH ,Booster MH ,Stubenitski BM ,de Boer J ,Heineman E ,Kootstra G . Outcome of transplantation of non-heart-beating donor kidneys. Lancet 1995;345:1067-1070
CrossRef | Web of Science | Medline6
Gonzalez Segura C ,Castelao AM ,Torras J , et al. Long-term follow-up of transplanted non-heart-beating donor kidneys. Transplant Proc 1995;27:2948-2950
Web of Science | Medline7
Pacholczyk MJ ,Lagiewska B ,Szostek M , et al. Transplantation of kidneys harvested from non-heart-beating donors: early and long-term results. Transpl Int 1996;9:Suppl 1:S81-S83
CrossRef | Medline8
Balupuri S ,Buckley P ,Snowden C , et al. The trouble with kidneys derived from the non heart-beating donor: a single center 10-year experience. Transplantation 2000;69:842-846
CrossRef | Web of Science | Medline9
Casavilla A ,Ramirez C ,Shapiro R , et al. Experience with liver and kidney allografts from non-heart-beating donors. Transplantation 1995;59:197-203
CrossRef | Web of Science | Medline10
Metcalfe MS ,Butterworth PC ,White SA , et al. A case-control comparison of the results of renal transplantation from heart-beating and non-heart-beating donors. Transplantation 2001;71:1556-1559
CrossRef | Web of Science | Medline11
Orloff MS ,Reed AI ,Erturk E , et al. Nonheartbeating cadaveric organ donation. Ann Surg 1994;220:578-585
CrossRef | Web of Science | Medline12
Cho YW ,Terasaki PI ,Cecka JM ,Gjertson DW . Transplantation of kidneys from donors whose hearts have stopped beating. N Engl J Med 1998;338:221-225
Full Text | Web of Science | Medline13
Nicholson ML . Kidney transplantation from non-heart-beating donors. Transplant Proc 2001;33:3756-3758
CrossRef | Web of Science | Medline14
Kootstra G . Statement on non-heart-beating donor programs. Transplant Proc 1995;27:2965-2965
Web of Science | Medline15
Novick AC ,Hwei HH ,Steinmuller D , et al. Detrimental effect of cyclosporine on initial function of cadaver renal allografts following extended preservation: results of a randomised prospective study. Transplantation 1986;42:154-158
CrossRef | Web of Science | Medline16
Jain S ,Curwood V ,White SA ,Furness PN ,Nicholson ML . Sub-clinical acute rejection detected using protocol biopsies in patients with delayed graft function. Transpl Int 2000;13:Suppl 1:S52-S55
CrossRef | Medline17
Solez K ,Axelsen RA ,Benediktsson H , et al. International standardization of criteria for the histologic diagnosis of renal allograft rejection: the Banff working classification of kidney transplant pathology. Kidney Int 1993;44:411-422
CrossRef | Web of Science | Medline18
Schnuelle P ,Lorenz D ,Trede M ,Van Der Woude FJ . Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol 1998;9:2135-2141
Web of Science | Medline19
Harper AM, Rosendale JD. The UNOS OPTN waiting list and donor registry: 1988-1996. In: Terasaki PI, ed. Clinical transplants 1996. Los Angeles: UCLA Tissue Typing Laboratory, 1997:69-90.
20
Vanrenterghem Y . Cautious approach to use of non-heart-beating donors. Lancet 2000;356:528-528
CrossRef | Web of Science | Medline21
Nicholson ML . Renal transplantation from non-heart-beating donors. Br J Surg 1996;83:147-148
CrossRef | Web of Science | Medline22
Sanfilippo F ,Vaughn WK ,Spees EK ,Lucas BA . The detrimental effects of delayed graft function in cadaver donor renal transplantation. Transplantation 1984;38:643-648
CrossRef | Web of Science | Medline23
Localio AR ,Berlin JA ,Ten Have TR ,Kimmel SE . Adjustments for center in multicenter studies: an overview. Ann Intern Med 2001;135:112-123
Web of Science | Medline24
Ojo AO ,Wolfe RA ,Held PJ ,Port FK ,Schmouder RL . Delayed graft function: risk factors and implications for renal allograft survival. Transplantation 1997;63:968-974
CrossRef | Web of Science | Medline25
Troppmann C ,Gillingham KJ ,Benedetti E , et al. Delayed graft function, acute rejection, and outcome after cadaver renal transplantation. Transplantation 1995;59:962-968
CrossRef | Web of Science | Medline26
Shoskes DA ,Cecka JM . Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection. Transplantation 1998;66:1697-1701
CrossRef | Web of Science | Medline27
Gaber LW ,Gaber AO ,Hathaway DK ,Vera SR ,Shokouh-Amiri MH . Routine early biopsy of allografts with delayed function: correlation of histopathology and transplant outcome. Clin Transplant 1996;10:629-634
Web of Science | Medline28
de Mattos AM ,Olyaei AJ ,Bennett WM . Nephrotoxicity of immunosuppressive drugs: long-term consequences and challenges for the future. Am J Kidney Dis 2000;35:333-346
CrossRef | Web of Science | Medline29
Agha IA ,Rueda J ,Alvarez A , et al. Short course induction immunosuppression with thymoglobulin for renal transplant recipients. Transplantation 2002;73:473-475
CrossRef | Web of Science | Medline
- Citing Articles (101)
Citing Articles
1
A. R. Manara, P. G. Murphy, G. O'Callaghan. (2012) Donation after circulatory death. British Journal of Anaesthesia 108:suppl 1, i108-i121
CrossRef2
I. Abboud, D. Viglietti, C. Antoine, F. Gaudez, P. Meria, E. Tariel, P. Mongiat-Artus, F. Desgranchamps, F. Roussin, F. Fieux, L. Jacob, C. Randoux, C. Michel, M. Flamant, C. Lefaucheur, E. Pillebout, T. Serrato, M.-N. Peraldi, D. Glotz. (2011) Preliminary results of transplantation with kidneys donated after cardiocirculatory determination of death: a French single-centre experience. Nephrology Dialysis Transplantation
CrossRef3
S.R. Thornton, N. Hamilton, D. Evans, T. Fleming, E. Clarke, J. Morgan, N. Kadi. (2011) Outcome of Kidney Transplantation From Elderly Donors After Cardiac Death. Transplantation Proceedings 43:10, 3686-3689
CrossRef4
Peter S. Yoo, Kim M. Olthoff, Peter L. Abt. (2011) Donation after cardiac death in pediatric organ transplantation. Current Opinion in Organ Transplantation 16:5, 483-488
CrossRef5
K. J. Roberts, P. Muiesan. (2011) Abdominal organ donation after death. British Journal of Surgery 98:9, 1185-1187
CrossRef6
A.W. Cantafio, A.A.S. Dick, J.B. Halldorson, R. Bakthavatsalam, J.D. Reyes, J.D. Perkins. (2011) Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion. Clinical Transplantation 25:5, E530-E540
CrossRef7
J. Wind, M. G. J. Snoeijs, J. A. van der Vliet, B. Winkens, M. H. L. Christiaans, A. J. Hoitsma, L. W. E. van Heurn. (2011) Preservation of kidneys from controlled donors after cardiac death. British Journal of Surgery 98:9, 1260-1266
CrossRef8
E. E. de Vries, E. R. P. Hoogland, B. Winkens, M. G. Snoeijs, L. W. E. van Heurn. (2011) Renovascular Resistance of Machine-Perfused DCD Kidneys Is Associated with Primary Nonfunction. American Journal of Transplantationno-no
CrossRef9
Erwin J.O. Kompanje, Yorick J. de Groot, Jan Bakker. (2011) Is Organ Donation From Brain Dead Donors Reaching an Inescapable and Desirable Nadir?. Transplantation 91:11, 1177-1180
CrossRef10
A. W. N. Reid, S. Harper, C. H. Jackson, A. C. Wells, D. M. Summers, O. Gjorgjimajkoska, L. D. Sharples, J. A. Bradley, G. J. Pettigrew. (2011) Expansion of the Kidney Donor Pool by Using Cardiac Death Donors with Prolonged Time to Cardiorespiratory Arrest. American Journal of Transplantation 11:5, 995-1005
CrossRef11
Jentina Wind, ER Pieter Hoogland, LW Ernest van Heurn. (2011) Preservation techniques for donors after cardiac death kidneys. Current Opinion in Organ Transplantation 16:2, 157-161
CrossRef12
Alkesh Jani, Michael Zimmerman, Jessica Martin, Li Lu, Kultigin Turkmen, Kameswaran Ravichandran, Arijana Pacic, Danica Ljubanović, Charles L. Edelstein. (2011) Perfusion Storage Reduces Apoptosis in a Porcine Kidney Model of Donation After Cardiac Death. Transplantation 91:2, 169-175
CrossRef13
Nabil N. Dagher, Bonnie E. Lonze, Andrew L. Singer, Christopher E. Simpkins, Niraj M. Desai, Robert A. Montgomery, Dorry L. Segev. (2011) Outcomes and Discard of Kidneys From Pediatric Donors After Cardiac Death. Transplantation1
CrossRef14
Thomas A. Nakagawa, Steven S. Mou. 2011. The Process of Organ Donation and Pediatric Donor Management. , 122-131.
CrossRef15
Maarten G. J. Snoeijs, Bjorn Winkens, Martin B. A. Heemskerk, Andries J. Hoitsma, Maarten H. L. Christiaans, Wim A. Buurman, L. W. Ernest van Heurn. (2010) Kidney Transplantation From Donors After Cardiac Death: A 25-Year Experience. Transplantation 90:10, 1106-1112
CrossRef16
W. D. Irish, J. N. Ilsley, M. A. Schnitzler, S. Feng, D. C. Brennan. (2010) A Risk Prediction Model for Delayed Graft Function in the Current Era of Deceased Donor Renal Transplantation. American Journal of Transplantation 10:10, 2279-2286
CrossRef17
Vito Fanelli, Luciana Mascia. (2010) Anesthetic optimization for nonheartbeating donors. Current Opinion in Anaesthesiology 23:3, 406-410
CrossRef18
ER Pieter Hoogland, Maarten GJ Snoeijs, LW Ernest van Heurn. (2010) DCD kidney transplantation: results and measures to improve outcome. Current Opinion in Organ Transplantation 15:2, 177-182
CrossRef19
Scott D. Halpern, Robert D. Truog. (2010) Organ donors after circulatory determination of death: Not necessarily dead, and it does not necessarily matter*. Critical Care Medicine 38:3, 1011-1012
CrossRef20
Jong Man Kim, Sung Joo Kim. (2010) The Use of Non-Heart Beating Donors to Expand the Donor Pool. The Journal of the Korean Society for Transplantation 24:3, 165
CrossRef21
B. Riou. (2010) Prelievo di organi dai pazienti in stato di morte cerebrale e a cuore fermo. EMC - Urgenze 14:4, 1-13
CrossRef22
Eva E. de Vries, Maarten G. Snoeijs, Ernest van Heurn. (2010) Kidney donation from children after cardiac death*. Critical Care Medicine 38:1, 249-253
CrossRef23
R. E. Chudzinski, K. Khwaja, P. Teune, J. Miller, H. Tang, M. Pavlakis, C. Rogers, S. Johnson, S. Karp, D. Hanto, D. Mandelbrot. (2010) Successful DCD Kidney Transplantation Using Early Corticosteroid Withdrawal. American Journal of Transplantation 10:1, 115-123
CrossRef24
D. J. Reich, D. C. Mulligan, P. L. Abt, T. L. Pruett, M. M. I. Abecassis, A. D’Alessandro, E. A. Pomfret, R. B. Freeman, J. F. Markmann, D. W. Hanto, A. J. Matas, J. P. Roberts, R. M. Merion, G. B. G. Klintmalm, . (2009) ASTS Recommended Practice Guidelines for Controlled Donation after Cardiac Death Organ Procurement and Transplantation. American Journal of Transplantation 9:9, 2004-2011
CrossRef25
A. D. Barlow, M. S. Metcalfe, Y. Johari, R. Elwell, P. S. Veitch, M. L. Nicholson. (2009) Case-matched comparison of long-term results of non-heart beating and heart-beating donor renal transplants. British Journal of Surgery 96:6, 685-691
CrossRef26
Andrew T. Costarino. (2009) Our continued unrealized potential for organ donation after cardiac death*. Pediatric Critical Care Medicine 10:2, 267-269
CrossRef27
Sri G. Yarlagadda, Christina L. Klein, Alkesh Jani. (2008) Long-Term Renal Outcomes After Delayed Graft Function. Advances in Chronic Kidney Disease 15:3, 248-256
CrossRef28
Erik Schadde, Anthony M. D’Alessandro, Stuart J. Knechtle, Jon Odorico, Yolanda Becker, John Pirsch, Hans Sollinger, Luis A. Fernandez. (2008) Alemtuzumab induction and triple maintenance immunotherapy in kidney transplantation from donors after cardiac death. Transplant International 21:7, 625-636
CrossRef29
Halpern, Scott D., Shaked, Abraham, Hasz, Richard D., Caplan, Arthur L., . (2008) Informing Candidates for Solid-Organ Transplantation about Donor Risk Factors. New England Journal of Medicine 358:26, 2832-2837
Full Text30
Thomas D. Harter. (2008) Overcoming the Organ Shortage: Failing Means and Radical Reform. HEC Forum 20:2, 155-182
CrossRef31
Matthew J. Laugharne, Elaine Clarke, Mary E. Younie, Rachel J. Johnson, Christopher J. Rudge, Barry D. Pentlow, Justin D. Morgan, Christopher R. Dudley. (2008) A Novel Scheme for Graft Allocation in Non-Heart Beating Donor Renal Transplantation. Transplantation 85:11, 1663-1667
CrossRef32
Maryam Y. Naim, K Sarah Hoehn, Richard D. Hasz, Lori S. White, Mark A. Helfaer, Robert M. Nelson. (2008) The Children’s Hospital of Philadelphia’s experience with donation after cardiac death*. Critical Care Medicine 36:6, 1729-1733
CrossRef33
P. Murphy, A. Manara, D. Bell, M. Smith. (2008) Controlled non-heart beating organ donation: neither the whole solution nor a step too far. Anaesthesia 63:5, 526-530
CrossRef34
Mudit Mathur, Shelley Taylor, Kathyrne Tiras, Michele Wilson, Shamel Abd-Allah. (2008) Pediatric critical care nurses?? perceptions, knowledge, and attitudes regarding organ donation after cardiac death*. Pediatric Critical Care Medicine 9:3, 261-269
CrossRef35
Corinne Antoine, Frédéric Brun, Alain Tenaillon, Bernard Loty. (2008) Le prélèvement sur donneurs à cœur arrêté dans le cadre de la greffe rénale. Néphrologie & Thérapeutique 4:1, 5-14
CrossRef36
D. J. Isch. (2007) In defense of the reverence of all life: Heideggerean dissolution of the ethical challenges of organ donation after circulatory determination of death. Medicine, Health Care and Philosophy 10:4, 441-459
CrossRef37
Maarten G. J. Snoeijs, Angela J. E. Dekkers, Wim A. Buurman, Luc van den Akker, Rob J. T. J. Welten, Geert Willem H. Schurink, L W. Ernest van Heurn. (2007) In Situ Preservation of Kidneys From Donors After Cardiac Death. Annals of Surgery 246:5, 844-852
CrossRef38
Ana I. Sánchez-Fructuoso, Martin Giorgi, Alberto Barrientos. (2007) Kidney transplantation from non–heart-beating donors: a Spanish view. Transplantation Reviews 21:4, 249-254
CrossRef39
Maarten G.J. Snoeijs, L.W. Ernest van Heurn, Walther N.K.A. van Mook, Maarten H. Christiaans, Johannes P. van Hooff. (2007) Controlled donation after cardiac death: a European perspective. Transplantation Reviews 21:4, 219-229
CrossRef40
Mohamed Y. Rady, Joseph L. Verheijde, Joan McGregor. (2007) “Non-heart-beating,” or “cardiac death,” organ donation: Why we should care. Journal of Hospital Medicine 2:5, 324-334
CrossRef41
Anthony Monaco. (2007) Financial rewards for organ donation: are we getting closer?. Expert Review of Pharmacoeconomics & Outcomes Research 7:4, 303-307
CrossRef42
J. E. Locke, D. L. Segev, D. S. Warren, F. Dominici, C. E. Simpkins, R. A. Montgomery. (2007) Outcomes of Kidneys from Donors After Cardiac Death: Implications for Allocation and Preservation. American Journal of Transplantation 7:7, 1797-1807
CrossRef43
J Jessica Neilson, Rod Mateo, Sharad Sharma. (2007) Donation after cardiac death and liver transplantation. Current Opinion in Organ Transplantation 12:3, 220-223
CrossRef44
Constantinos Kokkinos, David Antcliffe, Theodore Nanidis, Ara W. Darzi, Paris Tekkis, Vassilios Papalois. (2007) Outcome of Kidney Transplantation From Nonheart-Beating Versus Heart-Beating Cadaveric Donors. Transplantation 83:9, 1193-1199
CrossRef45
Joseph L. Verheijde, Mohamed Y. Rady, Joan McGregor. (2007) Recovery of transplantable organs after cardiac or circulatory death: The end justifying the means. Critical Care Medicine 35:5, 1439-1440
CrossRef46
D. Gardiner, B. Riley. (2007) Non-heart-beating organ donation - solution or a step too far?. Anaesthesia 62:5, 431-433
CrossRef47
Y. Kubota, K. Hayakawa, H. Sasaki, M. Kusaka, T. Maruyama, R. Shiroki, K. Hoshinaga. (2007) Should We Discard the Graft? Analysis of the Renal Grafts with a Total Ischemia Time of More Than 24 Hours Donated After Cardiac Death. American Journal of Transplantation 7:5, 1177-1180
CrossRef48
M. G. J. Snoeijs, B. Wiermans, M. H. Christiaans, J. P. van Hooff, B. E. Timmerman, G. W. H. Schurink, W. A. Buurman, L. W. E. van Heurn. (2007) Recipient Hemodynamics During Non-Heart-Beating Donor Kidney Transplantation Are Major Predictors of Primary Nonfunction. American Journal of Transplantation 7:5, 1158-1166
CrossRef49
Mary Bennett, Niranjan Kissoon. (2007) Is Cardiopulmonary Resuscitation Warranted in Children Who Suffer Cardiac Arrest Post Trauma?. Pediatric Emergency Care 23:4, 267-272
CrossRef50
Shawn J Pelletier, Robert M Merion. (2007) Implications and outcomes of donors after cardiac death. Current Opinion in Organ Transplantation 12:2, 125-130
CrossRef51
Gauke Kootstra, Ernest van Heurn. (2007) Non-heartbeating donation of kidneys for transplantation. Nature Clinical Practice Nephrology 3:3, 154-163
CrossRef52
JogiRaju Tantravahi, Karl L. Womer, Bruce Kaplan. (2007) Why Hasn't Eliminating Acute Rejection Improved Graft Survival? *. Annual Review of Medicine 58:1, 369-385
CrossRef53
M. D. Doshi, L. G. Hunsicker. (2007) Short- and Long-Term Outcomes with the Use of Kidneys and Livers Donated after Cardiac Death. American Journal of Transplantation 7:1, 122-129
CrossRef54
David P. Foley, Ravi S. Chari. (2007) Ischemia-reperfusion injury in transplantation: novel mechanisms and protective strategies. Transplantation Reviews 21:1, 43-53
CrossRef55
Nicole A Weimert, Rita R Alloway. (2007) Renal Transplantation in High-Risk Patients. Drugs 67:11, 1603-1627
CrossRef56
Peter Abt, Randeep Kashyap, Mark Orloff, Ashok Jain, George Tsoulfas, Adel Bozorgzadeh, Kim Olthoff. (2006) Pediatric Liver and Kidney Transplantation With Allografts From DCD Donors: A Review of UNOS Data. Transplantation 82:12, 1708-1711
CrossRef57
H. K. Koh, M. D. Jacobson, A. M. Lyddy, K. J. O'Connor, S. M. Fitzpatrick, M. Krakow, C. M. Judge, H. R. Alpert, R. S. Luskin. (2006) A Statewide Public Health Approach to Improving Organ Donation: The Massachusetts Organ Donation Initiative. American Journal of Public Health 97:1, 30-36
CrossRef58
B. de Vries, M. G. J. Snoeijs, L. von Bonsdorff, L. W. Ernest van Heurn, J. Parkkinen, W. A. Buurman. (2006) Redox-Active Iron Released During Machine Perfusion Predicts Viability of Ischemically Injured Deceased Donor Kidneys. American Journal of Transplantation 6:11, 2686-2693
CrossRef59
M Susan Mandell, Stacy Zamudio, Debbie Seem, Lin J. McGaw, Geri Wood, Patricia Liehr, Angela Ethier, Anthony M. D???Alessandro. (2006) National evaluation of healthcare provider attitudes toward organ donation after cardiac death*. Critical Care Medicine PAP,
CrossRef60
Peter L. Abt, Carol A. Fisher, Arun K. Singhal. (2006) Donation after Cardiac Death in the US: History and Use. Journal of the American College of Surgeons 203:2, 208-225
CrossRef61
S. Gagandeep, L. Matsuoka, R. Mateo, Y. W. Cho, Y. Genyk, L. Sher, J. Cicciarelli, S. Aswad, N. Jabbour, R. Selby. (2006) Expanding the Donor Kidney Pool: Utility of Renal Allografts Procured in a Setting of Uncontrolled Cardiac Death.. American Journal of Transplantation 6:7, 1682-1688
CrossRef62
James F. Whiting, Francis Delmonico, Paul Morrissey, Giacomo Basadonna, Scott Johnson, W David Lewis, Richard Rohrer, Kevin O??Connor, James Bradley, Tammy D. Lovewell, George Lipkowitz. (2006) Clinical Results of an Organ Procurement Organization Effort to Increase Utilization of Donors after Cardiac Death. Transplantation 81:10, 1368-1371
CrossRef63
D. J. Cohen, L. St. Martin, L. L. Christensen, R. D. Bloom, R. S. Sung. (2006) Kidney and Pancreas Transplantation in the United States, 1995-2004. American Journal of Transplantation 6:5p2, 1153-1169
CrossRef64
M. G. J. Snoeijs, S. Schaefer, M. H. Christiaans, J. P. van Hooff, P. M. van den Berg-Loonen, C. J. Peutz-Kootstra, W. A. Buurman, L. W. E. van Heurn. (2006) Kidney Transplantation Using Elderly Non-Heart-Beating Donors: A Single-Center Experience. American Journal of Transplantation 6:5p1, 1066-1071
CrossRef65
Luis A. Fernandez, Antonio Di Carlo, Jon S. Odorico, Glen E. Leverson, Brian D. Shames, Yolanda T. Becker, L Thomas Chin, John D. Pirsch, Stuart J Knechtle, David P. Foley, Hans W. Sollinger, Anthony M. D??Alessandro. (2005) Simultaneous Pancreas-Kidney Transplantation From Donation After Cardiac Death. Annals of Surgery 242:5, 716-723
CrossRef66
Scott R. Johnson, Martha Pavlakis, Khalid Khwaja, Seth J. Karp, Michael Curry, Christopher C. Curran, Anthony P. Monaco, Douglas W. Hanto. (2005) Intensive Care Unit Extubation Does Not Preclude Extrarenal Organ Recovery from Donors after Cardiac Death. Transplantation 80:9, 1244-1250
CrossRef67
Paolo Muiesan, Raffaele Girlanda, Wayel Jassem, Hector Vilca Melendez, John O??Grady, Matthew Bowles, Mohamed Rela, Nigel Heaton. (2005) Single-Center Experience With Liver Transplantation From Controlled Non-Heartbeating Donors. Annals of Surgery 242:5, 732-738
CrossRef68
Richard J. Howard, Jesse D. Schold, Danielle L. Cornell. (2005) A 10-year Analysis of Organ Donation after Cardiac Death in the United States. Transplantation 80:5, 564-568
CrossRef69
Scott R. Johnson. (2005) Donors after Cardiac Death: Opportunity Missed. Transplantation 80:5, 569-570
CrossRef70
Karin M. Keizer, Johan W. de Fijter, Bernadette J. J. M. Haase-Kromwijk, Willem Weimar. (2005) Non???Heart-Beating Donor Kidneys in The Netherlands: Allocation and Outcome of Transplantation. Transplantation 79:9, 1195-1199
CrossRef71
Ana I. Sanchez-Fructuoso, Maria Marques, Jose Conesa, Natalia Ridao, Antolina Rodriguez, Julia Blanco, Alberto Barrientos. (2005) Use of different immunosuppressive strategies in recipients of kidneys from nonheart-beating donors. Transplant International 18:5, 596-603
CrossRef72
Michael A. Bos. (2005) Ethical and Legal Issues in Non???Heart-Beating Organ Donation. Transplantation 79:9, 1143-1147
CrossRef73
J.C. Rosenberg, T. Beyersdorf, R. Pietroski. (2005) Changes in Notification and Demographics of Deceased Donors During the Past Decade in the State of Michigan, USA. Transplantation Proceedings 37:2, 571-573
CrossRef74
Manuel Gomez del Moral, Beatriz Aviles, Ingrid K. Colberger, Yolanda Campos-Martin, Javier Suela, Joaquin Alvarez, M. Jesus Perez-Contin, Ana Sanchez-Fructuoso, Alberto Barrientos, Eduardo Martinez-Naves. (2005) Expression of adhesion molecules and RANTES in kidney transplant from nonheart-beating donors. Transplant International 18:3, 333-340
CrossRef75
E RAMOS. (2005) Viabilidad de injerto de pacientes con trasplante renal de donante de cadáver en asistolia. Revista Española de Medicina Nuclear 24:1, 32-37
CrossRef76
J. C. Bains, R. M. Sandford, N. R. Brook, S. A. Hosgood, G. R. R. Lewis, M. L. Nicholson. (2005) Comparison of renal allograft fibrosis after transplantation from heart-beating and non-heart-beating donors. British Journal of Surgery 92:1, 113-118
CrossRef77
M. Steven, N. Pace. (2005) Non-heart-beating organ donation. European Journal of Anaesthesiology 20:11, 855
CrossRef78
B. Cohen. (2004) Expanding the donor pool to increase renal transplantation. Nephrology Dialysis Transplantation 20:1, 34-41
CrossRef79
Bart de Vries, Sarah J. Walter, Carine J. Peutz-Kootstra, Tim G.A.M. Wolfs, L.W. Ernest van Heurn, Wim A. Buurman. (2004) The Mannose-Binding Lectin-Pathway Is Involved in Complement Activation in the Course of Renal Ischemia-Reperfusion Injury. The American Journal of Pathology 165:5, 1677-1688
CrossRef80
Srikanth Reddy, Miguel Zilvetti, Jens Brockmann, Andrew McLaren, Peter Friend. (2004) Liver transplantation from non-heart-beating donors: Current status and future prospects. Liver Transplantation 10:10, 1223-1232
CrossRef81
Rubin Zhang, Prem Kumar, T Ramcharan, Efrain Reisin. (2004) Kidney Transplantation: The Evolving Challenges. The American Journal of the Medical Sciences 328:3, 156-161
CrossRef82
Jeffrey T. Cooper, L. Thomas Chin, Nancy R. Krieger, Luis A. Fernandez, David P. Foley, Yolanda T. Becker, Jon S. Odorico, Stuart J. Knechtle, Munci Kalayoglu, Hans W. Sollinger, Anthony M. D'Alessandro. (2004) Donation After Cardiac Death: The University of Wisconsin Experience with Renal Transplantation. American Journal of Transplantation 4:9, 1490-1494
CrossRef83
M Nishikido, M Noguchi, S Koga, H Kanetake, T Harada, T Taguchi, J Watanabe, F Matsuya, M Hayashi. (2004) Different clinicopathological courses of two recipients of kidneys retrieved from the same non-heart beating donor. Clinical Transplantation 18:s11, 54-60
CrossRef84
Michael L. Nicholson, Sarah A. Hosgood, Matthew S. Metcalfe, Julian R. Waller, Nicholas R. Brook. (2004) A Comparison of Renal Preservation by Cold Storage and Machine Perfusion Using a Porcine Autotransplant Model. Transplantation 78:3, 333-337
CrossRef85
Akinlolu O. Ojo, Dennis Heinrichs, Jean C. Emond, Joshua J. McGowan, Mary K. Guidinger, Francis L. Delmonico, Robert A. Metzger. (2004) Organ donation and utilization in the USA. American Journal of Transplantation 4:s9, 27-37
CrossRef86
Bart de Vries, Sarah J. Walter, Leni von Bonsdorff, Tim G. A. M. Wolfs, L. W. Ernest van Heurn, Jaakko Parkkinen, Wim A. Buurman. (2004) Reduction of circulating redox-active iron by apotransferrin protects against renal ischemia-reperfusion injury1. Transplantation 77:5, 669-675
CrossRef87
José Ramón Nuñez, Andrés Varela, Francisco del Río, Pablo Gámez, Joaquín Calatayud, Mar Córdoba, Florentino Hernando, Piedad Ussetti, Ana Gómez, Maria Cruz Carreño, Antonio Torres, Javier Gómez, José Luis Balibrea, Ana López. (2004) Bipulmonary transplants with lungs obtained from two non–heart-beating donors who died out of hospital. The Journal of Thoracic and Cardiovascular Surgery 127:1, 297-299
CrossRef88
Jürgen H. Fischer, Claudia Funcke, Goichi Yotsumoto, Stephanie Jeschkeit-Schubbert, Ferdinand Kuhn-Régnier. (2004) Maintenance of physiological coronary endothelial function after 3.3 h of hypothermic oxygen persufflation preservation and orthotopic transplantation of non-heart-beating donor hearts. European Journal of Cardio-Thoracic Surgery 25:1, 98-104
CrossRef89
Muhammad A Gok, Brian K. Shenton, Pamela E. Buckley, Robert Peaston, Chris Cornell, Naeem Soomro, Bryon C. Jaques, Derek M. Manas, David Talbot. (2003) How to improve the quality of kidneys from non-heart-beating donors: a randomised controlled trial of thrombolysis in non???heart-beating donors. Transplantation 76:12, 1714-1719
CrossRef90
Hisashi Iwata, Yoshio Mori, Hisato Takagi, Koyo Shirahashi, Yukiomi Fukumoto, Yukio Umeda, Yoshimasa Mizuno, Shoji Yoshikawa, Hajime Hirose, Shinichi Ito, Yoshito Takahashi, Takashi Deguchi, Yuichi Iwaki. (2003) A clinical renal-transplant case from a non???heart-beating donor using percutaneous cardiopulmonary support. Transplantation 76:12, 1772-1773
CrossRef91
M. Steven, N. Pace. (2003) Non-heart-beating organ donation. European Journal of Anaesthesiology 20:11, 855-858
CrossRef92
Alejandra Otero, Manuel G??mez-Guti??rrez, Francisco Su??rez, Francisco Arnal, Ant??n Fern??ndez-Garc??a, Javier Aguirrezabalaga, Jos?? Garc??a-Buitr??n, Joaqu??n Alvarez, Rafael M????ez. (2003) Liver transplantation from Maastricht category 2 non-heart-beating donors. Transplantation 76:7, 1068-1073
CrossRef93
Venkatesh Krishnamurthi. (2003) RE: Long-Term Results of Renal Transplantation Using Kidneys Harvested from Non-Heartbeating Donors: A 15-Year Experience. The Journal of Urology 170:3, 927
CrossRef94
Antonio Lopez-Navidad, Francisco Caballero. (2003) Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool. Clinical Transplantation 17:4, 308-324
CrossRef95
Paolo Muiesan. (2003) Liver Transplantation From Controlled Non???Heart-Beating Donors: An Increased Incidence of Biliary Complications.. Transplantation 75:10, 1627-1628
CrossRef96
Wayel Jassem, Dicken D. H. Koo, Paolo Muiesan, Lucia Cerundolo, Mohamed Rela, Susan V. Fuggle, Nigel D. Heaton. (2003) Non-heart-beating versus cadaveric and living-donor livers: differences in inflammatory markers before transplantation. Transplantation 75:8, 1386-1390
CrossRef97
S Sudhindran, GJ Pettigrew, A Drain, M Shrotri, CJE Watson, NV Jamieson, JA Bradley. (2003) Outcome of transplantation using kidneys from controlled (Maastricht category 3) non-heart-beating donors. Clinical Transplantation 17:2, 93-100
CrossRef98
Gail A. Van Norman. (2003) Ethical issues and the role of anesthesiologists in non-heart-beating organ donation. Current Opinion in Anaesthesiology 16:2, 215-219
CrossRef99
Christoph Schwarz, Rainer Oberbauer. (2003) The influence of organ donor factors on early allograft function. Current Opinion in Urology 13:2, 99-104
CrossRef100
(2002) Kidney Transplantation from Donors without a Heartbeat. New England Journal of Medicine 347:22, 1799-1801
Full Text101
Cecka, J. Michael, . (2002) Donors without a Heartbeat. New England Journal of Medicine 347:4, 281-283
Full Text
- Letters
