Three out of the 4 rejected kidneys on account of poor macroscopic appearance had their ‘twin’ kidney transplanted with good results. In addition, eight kidneys were discarded because intra-renal vascular resistance was abnormally elevated during pulsatile perfusion.Among the EPZ-5676 mll 31 kidney grafts, 24 were transplanted in our institution and could enter our follow up. There was a rate of delayed graft function of 92%. The mean duration was 22 �� 9 days. Among these transplantations, three major complications led to graft loss: one untimely cessation of immunosuppressive therapy by the patient leading to acute rejection, one renal venous thrombosis with early graft removal, and one primary non function which may be related to longer warm ischaemia duration (185 minutes).

The serum creatinine evolution is shown in Figure Figure33 for the remaining 21 patients. At three months, creatinine level was 162 �� 69 ��mol/l and 152 �� 65 ��mol/l at six months. Creatinine clearance at one month was 28 �� 14 ml/min, and 58 �� 21 and 66 �� 24 ml/min at three and six months after transplantation, respectively (n = 22). Graft survival rate was 89% at three and six months.Figure 3Serum 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.Limited information was available through the Agence de la biom��decine for six out of the seven recipients transplanted elsewhere.

For a follow-up period ranging from 6 to 12 months, graft survival rate was 100% and mean serum creatinine level was 135 �� 53 ��mol/l.DiscussionThese data from uncontrolled NHBD showed that such a program was feasible in France and profitable in terms of successful organ transplantation. Indeed, even though only half of the out-of-hospital cardiac arrests that were proposed could enter this program and only one-quarter had their kidneys actually retrieved, this program provided at least 27 successful renal transplants, including 21 carried out at our institution, within 17 months.Renal transplantation remains the treatment of choice for patients with end-stage renal failure [16]. In 2007 in France, 2911 kidney grafts were provided by BDD for 90.6%, by living donors for 8% and from NHBD for 1.4%.

In 2007, 128 patients died on the waiting list for kidney transplantation. To counter the shortage of grafts, an alternative source was organ harvesting from NHBD. This procedure, previously described in Europe, Japan and the USA [2,3,5,17], concerned mainly Maastricht 3 category NHBD. If harvesting controlled donors (withdrawal of care) provokes ethical controversies [18-20], ‘uncontrolled donors’ triggers many organisational problems.In our institution, the initiation GSK-3 of this program proved satisfactory in many ways.