Nicholson M L, Metcalfe M S, White S A, Waller J R, Doughman T M, Horsburgh T, Feehally J, Carr S J, Veitch P S
Departments of Surgery and Nephrology, University of Leicester, Leicester General Hospital, Leicester, England,United Kingdom.
Kidney Int. 2000 Dec;58(6):2585-91. doi: 10.1046/j.1523-1755.2000.00445.x.
In an attempt to address the shortage of conventional kidney donors, a non-heart-beating donor (NHBD) organ retrieval program has been established. We compared the results of kidney transplants from NHBDs (N = 77) with those from heart-beating cadaveric (HBD; N = 224) and living donors (LD; N = 49), performed in the same eight-year period.
Patients dying after failed attempts at resuscitation in the accident department or after intracerebral hemorrhage/anoxia were considered as potential NHBDs. After death, in situ kidney perfusion and cooling were achieved using an intra-aortic catheter inserted via a femoral artery cut down. Kidney retrieval and transplant operations were performed using standard techniques.
The median (range) warm ischemic time for NHBD kidneys was 25 minutes (5 to 53 min). The initial function rates for NHBD, HBD, and LD transplants were 6.5, 76.3, and 93%, respectively. Primary nonfunction occurred in 5 of 75 evaluable NHBD transplants (7%) compared with only 6 out of 224 (2.7%) HBD and 1 out of 49 (2%) LD transplants (P = NS). Eighty-four percent of NHBD kidney recipients required postoperative dialysis for a median of 19 days. The mean (SD) serum creatinine at 12 months was 179 (73) micromol/L in NHBD kidneys compared with 152 (57) micromol/L for HBD kidneys and 138 (44) micromol/L for LD kidneys. The actuarial five-year graft survival rates for NHBD, HBD, and LD transplants were 79, 75, and 78%, respectively. During the period under study, NHBD organs accounted for 22% of the total renal transplant program.
Despite being associated with poor initial graft function, the long-term allograft survival of NHBD kidneys does not differ significantly from the results of HBD and LD transplants.
为应对传统肾供体短缺的问题，已建立了非心脏跳动供体（NHBD）器官获取项目。我们比较了在同一八年期间进行的来自NHBD（n = 77）、心脏跳动尸体供体（HBD；n = 224）和活体供体（LD；n = 49）的肾移植结果。
在急诊科复苏尝试失败后死亡或因脑出血/缺氧死亡的患者被视为潜在的NHBD。死亡后，通过经股动脉切开插入的主动脉内导管实现原位肾脏灌注和冷却。肾脏获取和移植手术采用标准技术进行。
NHBD肾脏的中位（范围）热缺血时间为25分钟（5至53分钟）。NHBD、HBD和LD移植的初始功能率分别为6.5%、76.3%和93%。75例可评估的NHBD移植中有5例（7%）发生原发性无功能，而224例HBD移植中仅6例（2.7%），49例LD移植中仅1例（2%）（P = 无显著性差异）。84%的NHBD肾移植受者术后需要透析，中位时间为19天。NHBD肾脏术后12个月时的平均（标准差）血清肌酐为179（73）微摩尔/升，HBD肾脏为152（57）微摩尔/升，LD肾脏为138（44）微摩尔/升。NHBD、HBD和LD移植的精算五年移植存活率分别为79%、75%和78%。在研究期间，NHBD器官占肾移植项目总数的22%。
尽管NHBD肾脏与较差的初始移植功能相关，但其长期同种异体移植存活率与HBD和LD移植的结果相比无显著差异。
