Goplani K R, Firoz A, Ramakrishana P, Shah P R, Gumber M R, Patel H V, Vanikar A V, Trivedi H L
Department of Nephrology, Institute of Kidney Diseases and Research Center, Ahmedabad, India.
Transplant Proc. 2010 Jan-Feb;42(1):171-4. doi: 10.1016/j.transproceed.2009.11.021.
Deceased donor organ transplantation (DDOT) accounts for <4% of renal transplants in India. Many volunteers come forth for organ donation with increasing awareness; unfortunately, the majority are marginal donors, but their rejection would hamper the DDOT program. Judicious use of marginal organs is a challenge for developing countries.
We performed 29 renal transplants from 21 expanded criteria donors (ECD) out of 115 DDOT between January 2006 to April 2009-10 dual (DKT) and 19 single (SKT). Fourteen donors had hypertension, a cerebrovascular accident as the cause of death, 9 had both, and 4 had diabetes. Mean donor age was 70.3 +/- 8.9 years. Decisions on the procedure were based upon frozen section biopsy in 13 of 21 donors. Mean DKT donor age was 76 +/- 9.7 years versu 64 +/- 5.7 years of SKT donors. The native kidney diseases were chronic glomerulonephritis (n = 14), diabetic nephropathy (n = 7), tubulointerstitial nephritis (n = 4) and polycystic kidney disease, focal segmental glomerulosclerosis, lupus nephritis and patchy cortical necrosis, (n = 1 each). Mean recipient age of DKT versus SKT was 43.5 versus 42.3 years. All recipients received rabbit anti-thymocyte globulin, followed by steroid, mycophenolate mofetil/calcinueurin inhibitor.
Over a mean follow-up of 341 days, the mean serum creatinine (SCr) of 25/29 patients was 1.60 mg/dL (range, 1.0-2.6). The mean SCr of SKT patients was 1.59 +/- 0.63 mg/dL and of DKT, 1.62 +/- 0.48 mg/dL. Ten patients had delayed graft function and 11 had biopsy proven acute tubular necrosis. Seven (24%) patients had rejection (grade 3 Banff update '05, type IA; 4, type 2A); 6 responded to antirejection; 1 graft was lost at 7 months due to chronic rejection. Three (10.3%) patients were lost, 1 each due to AMI, sepsis, and CMV disease.
In the circumstances of organ shortage, DDOT with expanded criteria donor is a feasible option.
在印度，已故捐赠者器官移植（DDOT）占肾移植的比例不到4%。随着意识的提高，许多志愿者前来进行器官捐赠；不幸的是，大多数是边缘捐赠者，但拒绝使用他们的器官会阻碍DDOT项目。明智地使用边缘器官对发展中国家来说是一项挑战。
2006年1月至2009年4月期间，在115例DDOT中，我们使用21例扩大标准捐赠者（ECD）进行了29例肾移植，其中10例为双肾移植（DKT），19例为单肾移植（SKT）。14名捐赠者患有高血压，因脑血管意外死亡，9名捐赠者同时患有高血压和脑血管意外,4名患有糖尿病。捐赠者平均年龄为70.3±8.9岁。21名捐赠者中有13名的手术决策基于冰冻切片活检。DKT捐赠者的平均年龄为76±9.7岁，而SKT捐赠者为64±5.7岁。原发肾病包括慢性肾小球肾炎（n = 14）、糖尿病肾病（n = 7）、肾小管间质性肾炎（n = 4）以及多囊肾病、局灶节段性肾小球硬化、狼疮性肾炎和斑片状皮质坏死（各n = 1）。DKT受者与SKT受者的平均年龄分别为43.5岁和42.3岁。所有受者均接受了兔抗胸腺细胞球蛋白，随后使用类固醇、霉酚酸酯/钙调神经磷酸酶抑制剂。
平均随访341天，29例患者中有25例的平均血清肌酐（SCr）为1.60mg/dL（范围为1.0 - 2.6）。SKT患者的平均SCr为1.59±0.63mg/dL，DKT患者为1.62±0.48mg/dL。10例患者出现移植肾功能延迟，11例经活检证实为急性肾小管坏死。7例（24%）患者发生排斥反应（2005年版Banff分级3级，IA型；4例，2A型）；6例对抗排斥治疗有反应；1例移植肾在7个月时因慢性排斥反应而丢失。3例（10.3%）患者死亡，分别因急性心肌梗死、败血症和巨细胞病毒病各1例。
在器官短缺的情况下，使用扩大标准捐赠者进行DDOT是一种可行的选择。
