Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157–1095, USA.
J Am Coll Surg. 2011 Apr;212(4):440-51; discussion 451-3. doi: 10.1016/j.jamcollsurg.2010.12.033.
Reports of kidney transplantation from donation after cardiac death (DCD) donors describe high rates of delayed graft function (DGF).
From April 1, 2003 to October 17, 2010, we performed 134 kidney transplants from DCD donors including 120 (90%) from standard-criteria donors (SCDs) and 14 (10%) from expanded-criteria donors (ECDs). Nineteen kidneys were recovered from donors managed with extracorporeal interval support for organ retrieval (EISOR) after cardiac arrest to minimize ischemic injury.
Comparison of donor and recipient characteristics found no differences for cases managed with or without EISOR. Overall actuarial patient survival rates were 93%, 91%, and 89% at 1, 3, and 5 years, respectively, with a mean follow-up of 31 months. Overall actuarial kidney graft survival rates were 89%, 76%, and 76% at 1, 3, and 5 years, respectively. Actuarial graft survival rates of DCD ECD kidneys were 58% and 48% at 1 and 3 years, compared with 90% and 79% at 1 and 3 years for non-ECD grafts (p = 0.013). DGF occurred in 73 patients (54%) overall and was reduced from 55% to 21% (p = 0.016) with the use of EISOR in locally recovered kidneys. The mean resistance value on machine perfusion and the mean estimated glomerular filtration rate 1 month after transplantation were both improved (p < 0.05) in kidneys from donors managed with EISOR. Mean initial hospital stay was reduced from 8.0 to 5.0 days in patients receiving kidneys recovered with EISOR (p = 0.04).
EISOR is associated with a lower rate of DGF, lower graft resistance on machine perfusion, and shorter initial hospitalization. Kidneys from DCD SCDs have excellent medium-term outcomes and represent an important means of expanding the donor pool. Kidneys from DCD ECDs have inferior outcomes.
有报道称，来自心死亡后捐献（DCD）供者的肾脏移植术后发生延迟肾功能恢复（DGF）的比例较高。
从 2003 年 4 月 1 日至 2010 年 10 月 17 日，我们共完成了 134 例 DCD 供者的肾脏移植，其中 120 例（90%）来自标准供者（SCD），14 例（10%）来自扩展标准供者（ECD）。19 例供肾是在心脏停搏后采用体外间隔器官支持（EISOR）来获取器官，以尽量减少缺血性损伤。
比较了有或无 EISOR 管理的病例，发现供者和受者特征没有差异。总的患者存活率在 1、3 和 5 年分别为 93%、91%和 89%，平均随访时间为 31 个月。总的肾脏移植物存活率在 1、3 和 5 年分别为 89%、76%和 76%。DCD-ECD 肾脏的移植物存活率在 1 年和 3 年时分别为 58%和 48%，而非-ECD 移植物在 1 年和 3 年时分别为 90%和 79%（p = 0.013）。总的 DGF 发生率为 73 例（54%），使用 EISOR 后局部回收的肾脏中 DGF 发生率从 55%降至 21%（p = 0.016）。EISOR 管理的供者的移植物在机器灌注时的平均阻力值和移植后 1 个月时的平均估计肾小球滤过率均有改善（p < 0.05）。接受 EISOR 回收的肾脏的患者的平均初始住院时间从 8.0 天减少到 5.0 天（p = 0.04）。
EISOR 与较低的 DGF 发生率、机器灌注时较低的移植物阻力和较短的初始住院时间相关。来自 DCD-SCD 的肾脏具有优异的中期结果，是扩大供者库的重要手段。来自 DCD-ECD 的肾脏的结果较差。
