在单一中心从非心脏跳动尸体供体获取的359个肾移植器官的转归情况。

The fate of 359 renal allografts harvested from non-heart beating cadaver donors at a single center.

作者信息

Hoshinaga K, Shiroki R, Fujita T, Kanno T, Naide Y

机构信息

Fujita Health University, Department of Urology, Aichi, Japan.

出版信息

Clin Transpl. 1998:213-20.

PMID:10503100

Abstract

The fates of 359 kidneys harvested from 181 non-heart beating donors (NHBD) at a single center, using a regional in situ cooling technique were retrospectively investigated. 1. Thirty-five kidneys (9.7%) were discarded mainly due to poor arterial perfusion and bacterial contamination. 2. The incidence of primary nonfunction in patients treated with Aza was significantly higher than that in patients receiving CsA or FK (20.5% [8 grafts] vs 6.0% [17 grafts], respectively, p < 0.01). 3. The incidences of immediate and delayed graft function were 16.1% and 77.9%, respectively, among 285 recipients treated with CsA/FK. The average of duration of posttransplant dialysis required in recipients with DGF was 13.7 days and the average lowest serum creatinine level in patients who recovered graft function was 1.58 mg/dl. 4. Patient survival rates in the CsA/FK group were 97.2%, 95.0%, 93.2% and 89.3% at one, 3, 5 and 10 years, respectively, and the graft survival rates at one, 3, 5 and 10 years were 83.3%, 72.0%, 64.7% and 48.6%, respectively. 5. Increasing donor age showed a significant correlation with increased serum creatinine levels as well as with prolonged posttransplant dialysis (p < 0.001 and p < 0.01, respectively). 6. Renal grafts from donors with cerebrovascular disease (CVD) had significantly higher lowest serum creatine levels than grafts from non-CVD donors (p < 0.0001). 7. Renal grafts harvested from NHBD using our in situ cooling technique had excellent renal function when the donor was young or the cause of death was non-CVD. However, when the donor was older (> or = 56 years) and the cause of death was CVD, the grafts were acceptable but the early posttransplant function was often impaired. 8. The current NHBD graft survival rate, the UNOS cadaveric renal graft survival rate and the Japanese living-related donor renal graft survival rate were almost identical at 10 years posttransplant. 9. NHBDs should provide an excellent opportunity to increase organ availability.

摘要

回顾性研究了在单一中心采用区域原位冷却技术从181名非心脏跳动供体（NHBD）获取的359个肾脏的转归情况。1. 35个肾脏（9.7%）被丢弃，主要原因是动脉灌注不良和细菌污染。2. 接受硫唑嘌呤治疗的患者原发性无功能发生率显著高于接受环孢素或他克莫司治疗的患者（分别为20.5% [8个移植物] 对6.0% [17个移植物]，p < 0.01）。3. 在285名接受环孢素/他克莫司治疗的受者中，即时移植肾功能和延迟移植肾功能的发生率分别为16.1%和77.9%。移植肾功能延迟恢复的受者所需的移植后透析平均持续时间为13.7天，移植肾功能恢复的患者的血清肌酐平均最低水平为1.58 mg/dl。4. 环孢素/他克莫司组患者1年、3年、5年和10年的生存率分别为97.2%、95.0%、93.2%和89.3%，移植肾1年、3年、5年和10年的生存率分别为83.3%、72.0%、64.7%和48.6%。5. 供体年龄增加与血清肌酐水平升高以及移植后透析时间延长显著相关（分别为p < 0.001和p < 0.01）。6. 来自脑血管疾病（CVD）供体的肾移植的血清肌酐最低水平显著高于非CVD供体的肾移植（p < 0.0001）。7. 当供体年轻或死亡原因是非CVD时，采用我们的原位冷却技术从NHBD获取的肾移植具有良好的肾功能。然而，当供体年龄较大（≥56岁）且死亡原因是CVD时，移植肾是可以接受的，但移植后早期功能常受损。8. 在移植后10年，当前NHBD移植肾生存率、美国器官共享联合网络（UNOS）尸体肾移植生存率和日本活体亲属供肾移植生存率几乎相同。9. NHBD应提供增加器官可获得性的绝佳机会。