Locke J E, Segev D L, Warren D S, Dominici F, Simpkins C E, Montgomery R A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Transplant. 2007 Jul;7(7):1797-807. doi: 10.1111/j.1600-6143.2007.01852.x. Epub 2007 May 25.
Although donation after cardiac death (DCD) kidneys have a high incidence of delayed graft function (DGF) and have been considered marginal, no tool for stratifying risk of graft loss nor a specific policy governing their allocation exist. We compared outcomes of 2562 DCD, 62,800 standard criteria donor (SCD) and 12,812 expanded criteria donor (ECD) transplants reported between 1993 and 2005, and evaluated factors associated with risk of graft loss and DGF in DCD kidneys. Donor age was the only criterion used in the definition of ECD kidneys that independently predicted graft loss among DCD kidneys. Kidneys from DCD donors <50 had similar long-term graft survival to those from SCD (RR 1.1, p = NS). While DGF was higher among DCD compared to SCD and ECD, limiting cold ischemia (CIT) to <12 h decreased the rate of DGF 15% among DCD <50 kidneys. These findings suggest that DCD <50 kidneys function like SCD kidneys and should not be viewed as marginal or ECD, and further, limiting CIT <12 h markedly reduces DGF.
尽管心源性死亡后捐赠（DCD）的肾脏延迟移植肾功能（DGF）发生率很高，且一直被视为边缘性肾脏，但目前既没有评估移植肾丢失风险的工具，也没有针对其分配的具体政策。我们比较了1993年至2005年间报告的2562例DCD移植、62800例标准标准供体（SCD）移植和12812例扩展标准供体（ECD）移植的结果，并评估了与DCD肾脏移植肾丢失风险和DGF相关的因素。供体年龄是ECD肾脏定义中唯一独立预测DCD肾脏移植肾丢失的标准。来自年龄小于50岁的DCD供体的肾脏与来自SCD的肾脏具有相似的长期移植存活率（相对风险1.1，p=无显著性差异）。虽然与SCD和ECD相比，DCD中的DGF更高，但将冷缺血时间（CIT）限制在<12小时可使年龄小于50岁的DCD肾脏的DGF发生率降低15%。这些发现表明，年龄小于50岁的DCD肾脏功能与SCD肾脏相似，不应被视为边缘性或ECD肾脏，此外，将CIT限制在<12小时可显著降低DGF。
