Stratta Robert J, Rohr Michael S, Sundberg Aimee K, Armstrong Greg, Hairston Gloria, Hartmann Erica, Farney Alan C, Roskopf Julie, Iskandar Samy S, Adams Patricia L
Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Ann Surg. 2004 May;239(5):688-95; discussion 695-7. doi: 10.1097/01.sla.0000124296.46712.67.
To compare outcomes in recipients of expanded criteria donor (ECD) versus standard criteria donor (SCD) kidneys at a single center using a standardized approach with similar immunosuppression.
Expanded criteria deceased organ donors (ECD) are a source of kidneys that permit more patients to benefit from transplantation. ECD is defined as all deceased donors older than 60 years and donors older than 50 years with 2 of the following: hypertension, stroke as the cause of death, or pre-retrieval serum creatinine (SCr) greater than 1.5 mg/dl.
We retrospectively studied 90 recipients of adult deceased donor kidneys transplanted from October 1, 2001 to February 17, 2003, including 37 (41%) from ECDs and 53 (59%) from SCDs. ECD kidneys were used by matching estimated renal functional mass to recipient need, including the use of dual kidney transplants (n = 7). ECD kidney recipients were further selected on the basis of older age, HLA-matching, low allosensitization, and low body mass index. All patients received a similar immunosuppressive regimen. Minimum follow up was 9 months.
There were significant differences in donor and recipient characteristics between ECD and SCD transplants. Patient (99%) and kidney graft survival (88%) rates and morbidity were similar between the 2 groups, with a mean follow-up of 16 months. Initial graft function and the mean 1-week and 1-, 3-, 6-, 12-, and 18-month SCr levels were similar among groups.
The use of ECD kidneys at our center effectively doubled our transplant volume within 1 year. A systematic approach to ECD kidneys based on nephron mass matching and nephron sparing measures may provide optimal utilization with short-term outcomes and renal function comparable to SCD kidneys.
在单一中心采用标准化方法并使用相似免疫抑制方案，比较扩大标准供体（ECD）肾移植受者与标准标准供体（SCD）肾移植受者的结局。
扩大标准的已故器官供体（ECD）是肾脏的一个来源，能使更多患者从移植中获益。ECD定义为所有年龄大于60岁的已故供体以及年龄大于50岁且具备以下2项情况的供体：高血压、因中风死亡、或获取前血清肌酐（SCr）大于1.5mg/dl。
我们回顾性研究了2001年10月1日至2003年2月17日期间接受成人已故供体肾移植的90例受者，其中37例（41%）接受ECD供肾，53例（59%）接受SCD供肾。通过将估计的肾功能总量与受者需求相匹配来使用ECD供肾，包括采用双肾移植（n = 7）。ECD肾移植受者还根据年龄较大、HLA匹配、低致敏状态和低体重指数进行了进一步筛选。所有患者均接受相似的免疫抑制方案。最短随访时间为9个月。
ECD和SCD移植的供体和受者特征存在显著差异。两组患者的生存率（99%）和肾移植存活率（88%）以及发病率相似，平均随访时间为16个月。各组间初始移植肾功能以及1周、1、3、6、12和18个月时的平均SCr水平相似。
我们中心使用ECD供肾在1年内有效地使移植量增加了一倍。基于肾单位总量匹配和肾单位保留措施的ECD供肾系统方法，可能会实现最佳利用，其短期结局和肾功能与SCD供肾相当。
