Department of Nephrology, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
Nephrol Dial Transplant. 2010 Jun;25(6):1998-2004. doi: 10.1093/ndt/gfp779. Epub 2010 Jan 25.
Patients with blood group O have disadvantages in the allocation of deceased donor organs in the Eurotransplant Kidney Allocation System and fewer ABO-compatible living donors. In order to investigate the consequences of this dilemma, we analysed the outcome of patients with blood group O in our transplantation programme.
A single-centre analysis of 1186 waitlisted patients for first deceased donor kidney transplantations between 1996 and 2008 was performed, and the mechanisms of blood group-dependent differences for graft and recipient outcome were assessed.
Median follow-up time until death or end of observation for all waitlisted patients was 66 months (range, 0-158 months) and for 589 recipients of a kidney graft was 61 months (range, 0-158 months). Patients with blood group O had significantly longer waiting times for deceased donor kidney grafts, compared to non-group O recipients (median waiting time, 85 vs 59 months). As a consequence, blood group O patients had an increased risk for death without transplantation (13.1% for O patients vs 9.6% for non-O patients; P < 0.05). Despite a good human leukocyte antigen match, graft outcome tended to be worse in O recipients; 14.1% (95% CI, 8.2-19.9%) of all O kidneys from deceased donors were transplanted into non-O recipients, leading to the accumulation of O recipients on the waiting list.
The export of blood group O donor kidneys to other blood groups leads to longer waiting times, to a higher death rate and to accumulation of blood group O patients on the waiting list, which will further aggravate the problem in the future. Our results should prompt further research on the issues associated with blood group O. Current allocation systems and living donor kidney exchange programmes should be re-evaluated to address this problem.
在 Eurotransplant 肾脏分配系统中，O 型血患者在分配已故供体器官方面处于不利地位，且能匹配 ABO 血型的活体供者也较少。为了研究这一两难困境的后果，我们分析了我们移植项目中 O 型血患者的结局。
对 1996 年至 2008 年间 1186 例首次接受已故供体肾移植的候补患者进行了单中心分析，并评估了血型依赖性差异对移植物和受者结局的影响机制。
所有候补患者的中位随访时间直至死亡或观察终点为 66 个月（范围，0-158 个月），589 例接受肾移植患者的中位随访时间为 61 个月（范围，0-158 个月）。与非 O 型受者相比，O 型患者等待已故供体肾移植的时间明显更长（中位等待时间，85 与 59 个月）。因此，O 型患者在未进行移植的情况下死亡的风险增加（O 型患者 13.1%，而非 O 型患者 9.6%；P < 0.05）。尽管人类白细胞抗原匹配良好，但 O 型受者的移植物结局往往较差；14.1%（95%可信区间，8.2-19.9%）来自已故供者的 O 型肾脏被移植给非 O 型受者，导致 O 型受者在候补名单上的累积。
将 O 型供者的肾脏输出到其他血型会导致等待时间延长、死亡率升高，以及 O 型候补患者在候补名单上的累积，这将在未来进一步加剧这一问题。我们的研究结果应促使对与 O 型血相关的问题进行进一步研究。目前的分配系统和活体供者肾脏交换计划应重新评估，以解决这一问题。
