Doshi M D, Hunsicker L G
Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
Am J Transplant. 2007 Jan;7(1):122-9. doi: 10.1111/j.1600-6143.2006.01587.x. Epub 2006 Oct 25.
The shortage of deceased donor kidneys and livers for transplantation has prompted the use of organs from donors deceased after cardiac death (DCD). We used the UNOS database to examine patient and graft survival following transplantation of DCD organs compared to those following grafts from donors deceased after brain death (DBD; for livers, grafts from donors < 60 years old were labeled '< 60 yrs'). Of 44035 deceased donor kidney transplant recipients, 1177 (3%) received a DCD kidney. There was no difference in patient or graft survival at 5 years (DCD vs. DBD: 81.3% vs. 80.8% and 66.9% vs. 66.5%; p = 0.70 and p = 0.52 respectively). Of 24688-deceased donor liver transplant recipients, 345 (1.4%) were from DCD donors and 20289 (82%) were from '< 60 yrs' DBD donors. Three-year patient and graft survival were inferior in the DCD group (DCD vs. '< 60 yrs' DBD: 77% vs. 80% and 65% vs. 75%; p = 0.016 and p < 0.0001 respectively) but were comparable to current alternatives, '>/= 60 yrs' DBD livers (donor age >/= 60) and split livers. DCD livers are a reasonable option when death is imminent. Our study demonstrates good outcomes using DCD kidneys and livers and encourages their use.
用于移植的已故捐赠者肾脏和肝脏短缺，促使人们使用心脏死亡后捐赠者（DCD）的器官。我们使用器官共享联合网络（UNOS）数据库，对比了DCD器官移植后的患者和移植物存活率与脑死亡后捐赠者（DBD；对于肝脏，来自<60岁捐赠者的移植物标记为“<60岁”）移植后的情况。在44035例已故捐赠者肾移植受者中，1177例（3%）接受了DCD肾脏。5年时患者或移植物存活率无差异（DCD与DBD：81.3%对80.8%以及66.9%对66.5%；p分别为0.70和0.52）。在24688例已故捐赠者肝移植受者中，345例（1.4%）来自DCD捐赠者，20289例（82%）来自“<60岁”的DBD捐赠者。DCD组的3年患者和移植物存活率较低（DCD与“<60岁”DBD：77%对80%以及65%对75%；p分别为0.016和p<0.0001），但与当前的替代方案“≥60岁”DBD肝脏（捐赠者年龄≥60岁）和劈裂肝脏相当。当死亡即将发生时，DCD肝脏是一个合理的选择。我们的研究表明使用DCD肾脏和肝脏有良好的结果，并鼓励使用它们。
