Gok Muhammed A, Buckley Pamela E, Shenton Brian K, Balupuri Shlokark, El-Sheikh Mohammed A F, Robertson Helen, Soomro Naeem, Jaques Bryon C, Manas Derek M, Talbot David
Renal and Liver Transplant Unit, the Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, England, UK.
Transplantation. 2002 Sep 15;74(5):664-9. doi: 10.1097/00007890-200209150-00013.
Cadaveric kidneys from brain-stem-dead donors continue to be limited because the number of donors has reached a plateau. Wide recruitment of non-heart-beating donors (NHBD) could significantly increase the donor pool. NHBD renal transplants are underused because of the concern of poor quality graft function from such donors. In response to this perception, we reviewed 46 NHBD renal transplants performed in our center since 1998.
All NHBD kidneys were machine-perfused using the Newcastle continuous-hypothermic pulsatile preservation system before transplantation. A control heart-beating-donor (HBD) group was taken as the next consecutive HBD renal transplant to the NHBD transplant. The outcome and quality of function of the groups of renal transplants were analyzed for short-term and long-term performance.
The renal transplant patients were matched for donor and recipient factors. Survival rates for allografts and patients were similar for 1 to 3 years. There was an increased incidence of delayed graft function in the NHBD renal transplants in the perioperative period. The creatinine clearance was 22.8+/-2.3 mL/minute for NHBD patients and 44.4+/-2.9 mL/minute for HBD patients at the time of discharge from hospital. This difference equalized after 3 months and the creatinine clearance for NHBD was 44.2+/-2.4 mL/minute and for HBD 49.2+/-3.4 mL/minute.
Our results for NHBD renal transplants confirm that such grafts suffer primary warm ischemic injury, shown by the increased incidence of acute tubular necrosis and consequent delayed graft function. This produced poor renal function at the time of hospital discharge. After 3 months, the renal function of NHBD cases improved to the level seen in HBD patients.
由于供体数量已达平稳状态，脑干死亡供体的尸体肾数量仍然有限。广泛招募非心脏跳动供体（NHBD）可显著增加供体库。由于担心此类供体的移植物功能质量较差，NHBD肾移植未得到充分利用。针对这种看法，我们回顾了自1998年以来在本中心进行的46例NHBD肾移植。
所有NHBD肾在移植前均使用纽卡斯尔持续低温搏动保存系统进行机器灌注。将连续的下一例心脏跳动供体（HBD）肾移植作为NHBD移植的对照心脏跳动供体组。分析肾移植组的短期和长期性能的结果及功能质量。
肾移植患者在供体和受体因素方面相匹配。同种异体移植物和患者的1至3年生存率相似。NHBD肾移植围手术期移植肾功能延迟的发生率增加。NHBD患者出院时肌酐清除率为22.8±2.3毫升/分钟，HBD患者为44.4±2.9毫升/分钟。3个月后这种差异趋于平衡，NHBD的肌酐清除率为44.2±2.4毫升/分钟，HBD为为49.2±3.4毫升/分钟。
我们的NHBD肾移植结果证实，此类移植物遭受原发性热缺血损伤，表现为急性肾小管坏死发生率增加以及随之而来的移植肾功能延迟。这导致出院时肾功能较差。3个月后，NHBD病例的肾功能改善至HBD患者的水平。
