Sung R S, Christensen L L, Leichtman A B, Greenstein S M, Distant D A, Wynn J J, Stegall M D, Delmonico F L, Port F K
Scientific Registry of Transplant Recipients, Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Am J Transplant. 2008 Apr;8(4):783-92. doi: 10.1111/j.1600-6143.2008.02157.x. Epub 2008 Feb 19.
We examined factors associated with expanded criteria donor (ECD) kidney discard. Scientific Registry of Transplant Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data were examined for donor factors using logistic regression to determine the adjusted odds ratio (AOR) of discard of kidneys recovered between October 1999 and June 2005. Logistic and Cox regression models were used to determine associations with delayed graft function (DGF) and graft failure. Of the 12,536 recovered ECD kidneys, 5139 (41%) were discarded. Both the performance of a biopsy (AOR = 1.21, p = 0.02) and the degree of glomerulosclerosis (GS) on biopsy were significantly associated with increased odds of discard. GS was not consistently associated with DGF or graft failure. The discard rate of pumped ECD kidneys was 29.7% versus 43.6% for unpumped (AOR = 0.52, p < 0.0001). Among pumped kidneys, those with resistances of 0.26-0.38 and >0.38 mmHg/mL/min were discarded more than those with resistances of 0.18-0.25 mmHg/mL/min (AOR = 2.5 and 7.9, respectively). Among ECD kidneys, pumped kidneys were less likely to have DGF (AOR = 0.59, p < 0.0001) but not graft failure (RR = 0.9, p = 0.27). Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.
我们研究了与扩大标准供体（ECD）肾脏弃用相关的因素。利用逻辑回归分析科学移植受者登记系统（SRTR）/器官获取与移植网络（OPTN）的数据中的供体因素，以确定1999年10月至2005年6月间获取的肾脏被弃用的调整优势比（AOR）。采用逻辑回归模型和Cox回归模型来确定与移植肾功能延迟恢复（DGF）和移植失败的相关性。在12536个获取的ECD肾脏中，5139个（41%）被弃用。活检操作（AOR = 1.21，p = 0.02）以及活检时的肾小球硬化（GS）程度均与弃用几率增加显著相关。GS与DGF或移植失败之间并无一致的相关性。经泵灌注的ECD肾脏弃用率为29.7%，未经泵灌注的为43.6%（AOR = 0.52，p < 0.0001）。在经泵灌注的肾脏中，阻力为0.26 - 0.38和>0.38 mmHg/mL/min的肾脏比阻力为0.18 - 0.25 mmHg/mL/min的肾脏更易被弃用（AOR分别为2.5和7.9）。在ECD肾脏中，经泵灌注的肾脏发生DGF的可能性较小（AOR = 0.59，p < 0.0001），但与移植失败无关（风险比 = 0.9，p = 0.27）。活检结果和机器灌注是ECD肾脏弃用的重要相关因素；与移植失败的相应关联需要进一步研究。
