P.C. Butterworth

Work‐load generated by the establishment of a non‐heart beating kidney transplant programme

The work-load generated by a non-heart-beating donor (NHBD) kidney transplant programme over a 3-year period is reported. A total of 73 referrals were made, 64 from the Accident department and 9 from the wards. Organ procurement was performed in 24 cases (33%) and resulted in the retrieval of 44 kidneys. Reasons for failure to achieve organ procurement were: refused consent (n=13; 18%), relatives unavailable to ask for consent (n=9; 12%), technical problems with catheter insertion or perfusion (n=10; 14%), transplant staff unavailable (n=1; 1%), long asystolic period (n=8; 11%) and donor unsuitable for other reasons (n=8; 11%). Of the 44 kidneys retrieved, 30 were transplanted locally, 8 were transplanted at other United Kingdom centres and 6 were discarded. Locally transplanted NHBD kidneys represented 21% of the total transplant programme during the time period under study. We conclude that NHBD kidneys are a good source of additional organs for transplantation, but only one-third of referrals result in a successful procurement procedure. Moreover, the setting up of a successful programme is labour-intensive and requires a highly committed staff.

Renal tubular epithelial cells tolerate prolonged warm ischaemia in vitro.

AS INCREASING numbers of expanded criteria and non–heart-beating donor kidneys are procured, the need for a reliable, accurate test of viability prior to transplantation becomes more acute. An in vitro model of renal cellular ischaemia would facilitate the study and assessment of viability tests and renoprotective compounds. An experimental system for anoxic culture and manipulation of cultured cells has been established and used to study renal cell viability after an ischaemic insult.