Stratta Robert J, Moore Phillip S, Farney Alan C, Rogers Jeffrey, Hartmann Erica L, Reeves-Daniel Amber, Gautreaux Michael D, Iskandar Samy S, Adams Patricia L
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1095, USA.
J Am Coll Surg. 2007 May;204(5):873-82; discussion 882-4. doi: 10.1016/j.jamcollsurg.2007.01.032.
Expanded criteria donors (ECDs) increase the donor organ pool, but the value of transplanting these kidneys has been questioned because of concerns about diminished survival, poorer renal function, and higher rates of delayed graft function.
Retrospective analysis of intermediate-term outcomes in ECD kidney transplantations according to method of preservation at a single center using a standardized approach.
Over a 5-year period, we performed 141 donations-after-brain-death ECD kidney transplantations into adult recipients. A total of 114 kidneys (81%) were managed with combined cold-storage and pulsatile perfusion preservation (PPP), and the remaining 27 (19%) were preserved with cold storage (CS). The PPP group had a higher proportion of kidneys preserved for longer than 30 hours (28% versus 0, p < 0.001) and a longer mean cold ischemia time (24.5 hours PPP versus 19 hours CS, p < 0.01). Other donor and recipient characteristics were similar between groups. Incidence of delayed graft function was 11% in PPP-stored kidneys versus 37% in CS kidneys (p = 0.002). With a mean followup of 27 months, patient (91% PPP versus 96% CS) and kidney graft survival (81% PPP versus 81.5% CS) rates were comparable. Mean 12-month serum creatinine (1.9 mg/dL) and calculated Modification of Diet in Renal Disease glomerular filtration rate (41 mL/min) values were similar between groups.
Despite longer cold ischemia times, recipients of ECD kidneys managed with PPP had similar survival and functional outcomes, but experienced a marked reduction in the rate of delayed graft function.
扩大标准供体（ECD）增加了供体器官库，但由于担心其生存率降低、肾功能较差以及移植肾功能延迟发生率较高，移植这些肾脏的价值受到质疑。
采用标准化方法，对单中心ECD肾移植中期结果进行回顾性分析，分析依据保存方法。
在5年期间，我们对成年受者进行了141例脑死亡后ECD肾移植。总共114个肾脏（81%）采用冷藏与搏动灌注联合保存（PPP），其余27个（19%）采用冷藏（CS）保存。PPP组保存时间超过30小时的肾脏比例更高（28%对0，p<0.001），平均冷缺血时间更长（PPP组为24.5小时，CS组为19小时，p<0.01）。两组间其他供体和受体特征相似。PPP保存的肾脏移植肾功能延迟发生率为11%，而CS保存的肾脏为37%（p = 0.002）。平均随访27个月时，患者生存率（PPP组为91%，CS组为96%）和肾移植生存率（PPP组为81%，CS组为81.5%）相当。两组间平均12个月血清肌酐（1.9mg/dL）和计算的肾脏病饮食改良肾小球滤过率（41mL/min）值相似。
尽管冷缺血时间更长，但采用PPP管理的ECD肾受者生存率和功能结局相似，但移植肾功能延迟发生率显著降低。
