Jeffrey Segall

Cardiovascular disease in South Asians.

1 Bell DSH. Cardiovascular disease in South Asians. Lancet 2000; 356: 1109. 2 Anand SS, Salim Y, Vuksan V, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic Groups (SHARE). Lancet 2000; 356: 279–84. 3 Segall JJ. Dietary lactose as a possible risk factor for ischaemic heart disease: review of epidemiology. Int J Cardiol 1994; 46: 197–207. 4 Segall JJ. Epidemiological evidence for the link between dietary lactose and atherosclerosis. In: Colaco CALS, ed. The glycation hypothesis of atherosclerosis. Austin, Texas: Landes Bioscience, 1997: 186–209. of viability testing, merits further scrutiny. Although the rate of primary non-function fell from 54% to 7% among NHBDs, caution must be exercised in attributing this striking improvement entirely to viability testing. The earlier group of only 11 transplants, effectively historical controls, might simply represent a learning curve. Also the viability tests used were not validated, since kidneys thought to be non-viable were discarded. There was also a learning curve in the Leicester NHBD programme, reflected in a rate of primary non-function of 17% over the first 4 years, then 3% over the next 4 years. The latter is not significantly different from heartbeating-donor transplants. Assessment of kidneys is subjective, done according to the adequacy of in-situ perfusion. The drawbacks of this method are that substantial experience is needed to judge viability, and, in erring on the side of caution, viable kidneys might be discarded. A sensitive and specific viability test could allow more organs to be transplanted. This conjecture is lent some weight by comparison of the proportion of kidneys transplanted per NHBD in the two centres, which have similar referral criteria and protocols. In Newcastle, 1·4 kidneys are transplanted per retrieval, compared with 0·5 in Leicester. Finally, we feel that NHBDs need to be promoted broadly if they are to have an impact on the transplant waiting list. In Maastricht and Leicester, around 25% of renal transplants are from NHBDs. We recognise that concerns over viability present a substantial obstacle to this aim, and, therefore, we would welcome the development of a reliable objective test of viability.