Sudhindran S, Pettigrew G J, Drain A, Shrotri M, Watson C J E, Jamieson N V, Bradley J A
University Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
Clin Transplant. 2003 Apr;17(2):93-100. doi: 10.1034/j.1399-0012.2003.00014.x.
Many renal transplant centres are reluctant to use kidneys from non-heart-beating (NHB) donors because of the high incidence of primary non-function and delayed graft function reported in the literature. Here, we report our favourable experience of using kidneys from Maastricht category 3 donors (controlled NHB donors).
From January 1996 to June 2002, 42 renal transplants using kidneys from 25 controlled NHB donors were undertaken at our centre. The rates of primary non-function, delayed graft function (DGF), rejection and long-term graft and patient survival were compared with those of 84 recipients of grafts from heart-beating (HB donors) transplanted contemporaneously.
Primary non-function did not occur in recipients of grafts from NHB donors but was seen in two grafts from HB donors. DGF occurred in 21 of 42 (50%) kidneys from NHB donors and 14 of 84 (17%) kidneys from HBD donars (p < 0.001). The acute rejection rates in the two groups were similar (33% for grafts from NHB donors vs. 40% from HB donors). By 1 month after transplantation, there was no significant difference in serum creatinine concentration between the two groups. Over a median follow-up period of 32 months (range 2-75 months), the actuarial graft survival rates at 1, 3 and 5 yr after transplantation were 84, 80 and 74% for recipients of kidneys from NHB donors, compared with 89, 85 and 80% for kidneys from HB donors.
Controlled NHB donors are a valuable and under-used source of kidneys for renal transplantation. The outcome for recipients of kidney allografts from category 3 NHB donors is similar to that seen in recipients of grafts from conventional HB cadaveric donors.
由于文献报道原发性无功能和移植肾功能延迟发生率较高，许多肾移植中心不愿使用非心脏跳动（NHB）供者的肾脏。在此，我们报告使用马斯特里赫特3类供者（控制性NHB供者）肾脏的良好经验。
1996年1月至2002年6月，我们中心采用25例控制性NHB供者的肾脏进行了42例肾移植。将原发性无功能、移植肾功能延迟（DGF）、排斥反应以及长期移植肾和患者生存率与同期84例接受心脏跳动（HB）供者移植肾的受者进行比较。
NHB供者移植肾的受者未发生原发性无功能，但在2例HB供者的移植肾中出现。42例NHB供者的肾脏中有21例（50%）发生DGF，84例HBD供者的肾脏中有14例（17%）发生DGF（p < 0.001）。两组的急性排斥反应发生率相似（NHB供者移植肾为33%，HB供者移植肾为40%）。移植后1个月时，两组血清肌酐浓度无显著差异。在中位随访期32个月（范围2 - 75个月）内，NHB供者肾脏受者移植后1、3和5年的移植肾 actuarial 生存率分别为84%、80%和74%，而HB供者肾脏受者分别为89%、85%和80%。
控制性NHB供者是肾移植中一种有价值但未得到充分利用的肾脏来源。3类NHB供者同种异体肾移植受者的结局与传统HB尸体供者移植肾受者的结局相似。
