Goldsmith P J, Ridgway D M, Pine J K, Ecuyer C, Baker R, Newstead C, Hostert L, Pollard S G, Attia M, Menon K V, Ahmad N
Department of Organ Transplantation, St James’s University Hospital, Leeds, United Kingdom.
Transplant Proc. 2010 Dec;42(10):3960-2. doi: 10.1016/j.transproceed.2010.09.135.
The United Kingdom has no national sharing scheme for kidneys received from donation after cardiac death (DCD). Therefore, both kidneys retrieved by a transplant team are implanted at a single unit, often sequentially. This study analyzes the impact of a prolonged cold ischaemia time on the second transplanted kidney and the effects on short-term and long-term outcomes in all our DCD renal implants from 2002 to 2009. Cold ischaemia time was significantly longer with the second kidney (P = .04) as was delayed graft function (P = .02). Acute rejection was increased in the first transplanted kidney (P < .001). Five-year patient survival was comparable between groups, but 5-year graft survival was higher in the second transplanted group (P = .04). The results confirm that, provided recipient centers are willing to accept higher initial rates of delayed graft function, it is acceptable to transplant DCD grafts sequentially without jeopardizing long-term graft or recipient outcome.
英国没有针对心脏死亡后捐赠肾脏（DCD）的全国性共享计划。因此，移植团队获取的两个肾脏通常会依次植入同一个单位。本研究分析了冷缺血时间延长对第二个移植肾脏的影响，以及对2002年至2009年我们所有DCD肾移植受者短期和长期结局的影响。第二个肾脏的冷缺血时间明显更长（P = 0.04），移植肾功能延迟的情况也是如此（P = 0.02）。第一个移植肾脏的急性排斥反应有所增加（P < 0.001）。两组之间的5年患者生存率相当，但第二个移植组的5年移植物生存率更高（P = 0.04）。结果证实，只要受者中心愿意接受更高的初始移植肾功能延迟发生率，依次移植DCD移植物是可以接受的，不会危及移植物或受者的长期结局。
