Lee C M, Carter J T, Randall H B, Hiose R, Stock P G, Melzer J S, Dafoe D C, Freise C E, Alfrey E J
Department of Surgery, University of California, San Francisco, San Francisco, California 94143, USA.
J Surg Res. 2000 Jun 1;91(1):83-8. doi: 10.1006/jsre.2000.5921.
National sharing of cadaveric renal allografts for perfectly matched kidneys (0 antigen mismatch) has improved outcome in the recipients of these kidneys despite increasing cold storage times. However, there may be limits to outcome improvement of matched kidneys based on age and cold storage time.
To determine if national sharing of kidneys based on matching improves outcome regardless of donor age and cold storage time, we evaluated the United Network for Organ Sharing (UNOS) Scientific Registry for all recipients of cadaveric kidney transplants between January 1, 1990 and July 31, 1998. We divided the recipients into four groups based on donor age and cold storage time. Group 1 comprised young donors (donor age <55 years) with average (<24 h) cold storage time; group 2, young donors with long (>/=24 h) cold storage time; group 3, older donors (donor age >/=55 years) with average cold storage time; and group 4, older donors with long cold storage time.
A total of 64,046 recipients were evaluated: 35,061 (55%) in group 1, 21,264 (33%) in group 2, 4308 (7%) in group 3, and 3414 (5%) in group 4. Early graft performance progressively decreased from group 1 to group 4. Delayed graft function (DGF: dialysis requirement in the first 7 days posttransplant) was 18, 29, 33, and 42% (P < 0.0001); serum creatinine at 3 years (in mg/dl) was 1.70 +/- 0.8, 1.73 +/- 0.9, 2. 31 +/- 1.0, and 2.42 +/- 1.1 (P < 0.0001); 1-year graft survival was 87, 84, 79, and 77% (P < 0.0001); and 3-year graft survival was 77, 74, 63, and 62% (P < 0.0001, for groups 1 and 2 vs groups 3 and 4, respectively). The trends in DGF persisted through the groups in 0 antigen mismatched kidneys.
Early function is adversely affected by prolonged cold storage, despite matching, in recipients of younger and older donor kidneys. Long-term function does not appear to be affected by prolonged cold storage. Recipients of kidneys from donors >/=55 years of age have significantly worse short- and long-term outcome and may not benefit from national sharing.
尽管冷缺血时间延长，但全国范围内共享完全匹配的尸体肾移植（0抗原错配）已改善了这些肾脏受者的预后。然而，基于年龄和冷缺血时间，匹配肾脏的预后改善可能存在限度。
为了确定基于匹配的全国肾脏共享是否能改善预后，而不考虑供体年龄和冷缺血时间，我们评估了器官共享联合网络（UNOS）科学登记处1990年1月1日至1998年7月31日期间所有尸体肾移植受者的情况。我们根据供体年龄和冷缺血时间将受者分为四组。第1组包括年轻供体（供体年龄<55岁）且冷缺血时间平均（<24小时）；第2组，年轻供体且冷缺血时间长（≥24小时）；第3组，老年供体（供体年龄≥55岁）且冷缺血时间平均；第4组，老年供体且冷缺血时间长。
共评估了64046名受者：第1组35061名（55%），第2组21264名（33%），第3组4308名（7%），第4组3414名（5%）。从第1组到第4组，早期移植肾功能逐渐下降。移植肾功能延迟（DGF：移植后第1个7天内需要透析）分别为18%、29%、33%和42%（P<0.0001）；3年时血清肌酐（mg/dl）分别为1.70±0.8、1.73±0.9、2.31±1.0和2.42±1.1（P<0.0001）；1年移植肾存活率分别为87%、84%、79%和77%（P<0.0001）；3年移植肾存活率分别为77%、74%、63%和62%（第1组和第2组与第3组和第4组相比，P<0.0001）。在0抗原错配的肾脏中，DGF的趋势在各组中持续存在。
在年轻和老年供体肾脏的受者中，尽管进行了匹配，但冷缺血时间延长会对早期功能产生不利影响。长期功能似乎不受冷缺血时间延长的影响。年龄≥55岁供体的肾脏受者短期和长期预后明显较差，可能无法从全国范围内的共享中获益。
