Matsuoka L, Shah T, Aswad S, Bunnapradist S, Cho Y, Mendez R G, Mendez R, Selby R
National Institute of Transplantation, Los Angeles, California, USA.
Am J Transplant. 2006 Jun;6(6):1473-8. doi: 10.1111/j.1600-6143.2006.01323.x.
The use of expanded criteria donors (ECD) has been proposed to help combat the discrepancy between organ availability and need. ECD kidneys are associated with delayed graft function (DGF) and worse long-term survival. The aim of this study is to evaluate the impact of pulsatile perfusion (PP) on DGF and graft survival in transplanted ECD kidneys. From January 2000 to December 2003, 4618 ECD kidney-alone transplants were reported to the United Network for Organ Sharing. PP was performed on 912 renal allografts. The prognostic factors of DGF were analyzed using multivariate logistic regression analysis. Risk factors for reduced allograft viability were greater in donors and recipients of PP kidneys. Three-year graft survival of ECD kidneys preserved with PP was similar to cold storage (CS) kidneys. The incidence of DGF in PP kidneys was significantly lower than CS kidneys (26% vs. 36%, p < 0.001). Despite having a greater number of risk factors for reduced graft viability, the ECD-PP kidneys had similar graft survival compared to ECD-CS kidneys. The use of PP, by decreasing the incidence of DGF, may possibly lead to lower overall costs and increased utilization of donor kidneys.
有人提议使用扩大标准供体（ECD）来帮助解决器官供应与需求之间的差距。ECD肾脏与移植肾功能延迟（DGF）及较差的长期存活率相关。本研究的目的是评估搏动灌注（PP）对ECD肾脏移植中DGF和移植肾存活的影响。2000年1月至2003年12月，共有4618例单独的ECD肾脏移植报告给器官共享联合网络。对912例同种异体肾移植进行了PP。采用多因素logistic回归分析DGF的预后因素。PP肾脏供体和受体中移植肾存活降低的危险因素更多。用PP保存的ECD肾脏的三年移植肾存活率与冷保存（CS）肾脏相似。PP肾脏中DGF的发生率显著低于CS肾脏（26%对36%，p<0.001）。尽管ECD-PP肾脏存在更多降低移植肾存活的危险因素，但与ECD-CS肾脏相比，其移植肾存活率相似。通过降低DGF的发生率，PP的使用可能会降低总体成本并提高供体肾脏的利用率。
