Nishikido M, Noguchi M, Koga S, Kanetake H, Matsuya F, Hayashi M, Hori T, Shindo K
Department of Urology, Nagasaki University School of Medicine, Nagasaki, Japan.
Transplant Proc. 2004 Sep;36(7):1888-90. doi: 10.1016/j.transproceed.2004.06.030.
Most donors in Japan have been non-heart-beating donors (NHBD), so-called "marginal donors." In Western countries kidney transplants from NHBD have also been increasing. We analyzed 120 kidneys harvested from NHBD with regard to organ procurement, renal function, graft survival, and the donor factors that affected graft survival.
Donors were moved into the operating room after cardiac arrest. A double-balloon catheter was inserted into the abdominal aorta via laparotomy. In situ cooling by Euro-Collins solution was started at 500 mL/min. We did not performed cannulation into the femoral artery or vein prior to cardiac arrest.
Warm ischemia time (WIT) was 18.6 minutes. Among 108 kidneys (90%) used for transplantation, 102 kidneys functioned. There were no cases of bilateral nonfunctioning kidneys. The delayed graft function (DGF) rate was 86%; however, the death-censored graft survival was 80.0% at 5 years and 62.9% at 10 years. Kidneys implanted after more than 24 hours of total ischemia time required a significantly longer period of hemodialysis. Donor risk factors that affected graft survival included WIT >/= 20 minutes, donor age >/= 50 years, and serum creatinine level at admission > 1.0 mg/dL.
Organ procurement without cannulation prior to cardiac arrest entailed a long WIT and a high DGF rate. However, the graft survival was good. It has been necessary to use grafts from NHBD despite the inherent risk factors. It is important to reduce kidney damage both at the organ procurement and during the posttransplant management.
在日本，大多数供体为非心脏跳动供体（NHBD），即所谓的“边缘供体”。在西方国家，来自非心脏跳动供体的肾移植数量也在增加。我们分析了120例从非心脏跳动供体获取的肾脏，涉及器官获取、肾功能、移植物存活情况以及影响移植物存活的供体因素。
供体心脏骤停后被送入手术室。通过剖腹术将双球囊导管插入腹主动脉。以500毫升/分钟的速度开始用欧洲柯林斯溶液进行原位降温。在心脏骤停前未进行股动脉或股静脉插管。
热缺血时间（WIT）为18.6分钟。在用于移植的108个肾脏（90%）中，102个肾脏发挥了功能。没有出现双侧无功能肾脏的病例。延迟移植肾功能（DGF）率为86%；然而，在5年时，死亡截尾的移植物存活率为80.0%，在10年时为62.9%。总缺血时间超过24小时后植入的肾脏需要显著更长时间的血液透析。影响移植物存活的供体风险因素包括热缺血时间≥20分钟、供体年龄≥50岁以及入院时血清肌酐水平>1.0毫克/分升。
在心脏骤停前不进行插管的器官获取方式导致热缺血时间长且延迟移植肾功能率高。然而，移植物存活情况良好。尽管存在固有风险因素，但仍有必要使用来自非心脏跳动供体的移植物。在器官获取和移植后管理过程中减少肾脏损伤非常重要。
