Palmes Daniel, Wolters Heiner Hubert, Brockmann Jens, Senninger Norbert, Spiegel Hans-Ullrich, Dietl Karl-Heinz
Surgical Research, Department of General Surgery, Münster University Hospital, Waldeyerstrasse 1, D-48149 Münster, Germany.
Nephrol Dial Transplant. 2004 Apr;19(4):952-62. doi: 10.1093/ndt/gfh043.
The living-donor and dual kidney transplantation programmes were initiated in the transplantation centre of Münster (TCM) as two approaches to compensate for the declining numbers of cadaver donor kidney transplants after the implementation of the new Eurotransplant Kidney Allocation System (ETKAS). We analysed the outcome of cadaver, living-donor and dual kidney transplantation and their effects on the waiting list in the TCM.
Between January 1990 and December 2000, 1184 kidney transplants were performed in the TCM. They were subdivided into cadaver, living-donor and dual kidney transplants and retrospectively analysed in terms of the number of kidney transplants performed, waiting time and waiting coefficient. In addition four representative groups were formed to reflect donor origin (I: cadaver kidney transplants allocated by the old ETKAS, n = 180; II: cadaver kidney transplants allocated by the new ETKAS, n = 139; III: living-donor kidney transplantation, n = 59; IV: dual kidney transplantation, n = 31) and compared according to graft function (initial diuresis, creatinine, 3-year graft function), patient survival and median waiting time.
After the implementation of the new ETKAS, the number of cadaver donor kidney transplants at the TCM almost halved, but the proportion of living-donor kidney transplantations increased significantly by 12.8% and of dual kidney transplantations by 8.5%. Patients who had received kidneys from cadaver donors allocated by the new ETKAS (group II) had a better survival rate, short- and long-term function but a longer waiting time than in group I (old ETKAS). Patients with dual kidney transplants (group IV) showed the lowest survival and short-term function rate, but had long-term function equivalent to that of cadaver kidney transplants (groups I and II). Patients who had received kidneys from living donors (group III) had the best survival, and short- and long-term function rate as well as the shortest mean waiting time.
Living-donor and dual kidney transplantation proved to be functionally equivalent alternatives and successful strategies for compensating the declining numbers of cadaver donor kidney transplants.
明斯特移植中心启动了活体供肾和双肾移植项目，作为在新的欧洲移植肾脏分配系统（ETKAS）实施后，弥补尸体供肾移植数量下降的两种方法。我们分析了明斯特移植中心尸体、活体供肾和双肾移植的结果及其对等待名单的影响。
1990年1月至2000年12月期间，明斯特移植中心共进行了1184例肾移植。这些移植被分为尸体、活体供肾和双肾移植，并根据肾移植数量、等待时间和等待系数进行回顾性分析。此外，还形成了四个代表性组以反映供体来源（I：由旧ETKAS分配的尸体肾移植，n = 180；II：由新ETKAS分配的尸体肾移植，n = 139；III：活体供肾移植，n = 59；IV：双肾移植，n = 31），并根据移植功能（初始利尿、肌酐、3年移植功能）、患者生存率和中位等待时间进行比较。
新ETKAS实施后，明斯特移植中心尸体供肾移植数量几乎减半，但活体供肾移植比例显著增加了12.8%，双肾移植比例增加了8.5%。接受新ETKAS分配的尸体供肾的患者（II组）比I组（旧ETKAS）有更好的生存率、短期和长期功能，但等待时间更长。双肾移植患者（IV组）的生存率和短期功能率最低，但长期功能与尸体肾移植患者（I组和II组）相当。接受活体供肾的患者（III组）生存率最高，短期和长期功能率也最高，平均等待时间最短。
活体供肾和双肾移植被证明是功能上等效的替代方法，也是弥补尸体供肾移植数量下降的成功策略。
