心脏死亡后捐赠的肾移植：从撤除生命支持到心脏停搏的持续时间的影响

Renal transplantation following donation after cardiac death: impact of duration from withdrawal to asystole.

作者信息

Goldsmith P J, Pine J K, Ridgway D M, Ecuyer C, Pollard S G, Attia M, Menon K V, Ahmad N

机构信息

Department of Organ Transplantation, St James’s University Hospital, Leeds, United Kingdom.

出版信息

Transplant Proc. 2010 Dec;42(10):3966-7. doi: 10.1016/j.transproceed.2010.09.136.

DOI:10.1016/j.transproceed.2010.09.136

PMID:21168601

Abstract

Donation after cardiac death (DCD) allows for expansion of the donor pool, however, the process for DCD donation can lead to a donor's physiological instability before asystole. This may have a detrimental effect on graft and patient outcomes. We analyzed all 201 DCD donations at our unit from 2002 to 2009 and compared short versus long durations to asystole around the median time (20 min). Delayed graft function was comparable between the groups (P = .13), primary nonfunction was increased in the long duration to asystole group (P < .0001), and acute rejection was increased in the short duration group (P < .001). Five year patient survival was comparable (P = .6). In conclusion, long duration asystole may have an immediate effect on graft survival, but it has no overall detrimental effect on longer-term outcomes. Further studies are required to investigate the acceptable time to wait from withdrawal to asystole.

摘要

心脏死亡后器官捐献（DCD）有助于扩大供体库，然而，DCD捐献过程可能会导致供体在心跳停止前出现生理不稳定。这可能会对移植物和患者的预后产生不利影响。我们分析了2002年至2009年在我们单位进行的所有201例DCD捐献，并比较了心跳停止时间短于或长于中位数时间（20分钟）的情况。两组之间延迟移植功能相当（P = 0.13），心跳停止时间长的组原发性无功能增加（P < 0.0001），而心跳停止时间短的组急性排斥反应增加（P < 0.001）。五年患者生存率相当（P = 0.6）。总之，心跳停止时间长可能会对移植物存活产生即时影响，但对长期预后没有总体不利影响。需要进一步研究来调查从撤除生命支持到心跳停止的可接受等待时间。