Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Clin Transplant. 2011 Nov-Dec;25(6):E612-6. doi: 10.1111/j.1399-0012.2011.01510.x. Epub 2011 Sep 15.
To determine to what extent current cold ischemia times (CITs) affect the results of renal transplantation in the Netherlands.
Retrospective survey of the Dutch Organ Transplant Registry concerning transplants from deceased donors between 1990 and 2007.
A total of 6322 recipients were identified, of whom 5306 received a kidney from deceased heartbeating (HBD) and 1016 from donors after cardiac death (DCD). Mean CIT was 24.0 ± 7.9 h in HBD and 21.6 ± 6.7 h in DCD. The percentage delayed graft function (DGF) was 12.3 and 50.4, respectively (p < 0.001). Primary non-function (PNF) occurred in, respectively, 1.7% and 5.0% (p < 0.001). Serum creatinine after three months was 166 μM in HBD and 213 μM in DCD (p < 0.001). Five-yr graft survival was 79.5% and 78.3%, respectively (p = ns). In multivariate analysis, CIT proved to be an independent risk factor for DGF and PNF. Shorter CIT was associated with better graft survival in both groups with a hazard ratio of 1.024 (1.011-1.037, 95% CI)/h. CIT <20 h was associated with a graft survival benefit of 3% after five yr in HBD and CIT of <16 h with a benefit of 10% in DCD.
Longer CITs are associated with the occurrence of DGF, PNF and decreased graft survival in the Netherlands.
确定目前的冷缺血时间（CIT）在多大程度上影响荷兰肾移植的结果。
对荷兰器官移植登记处 1990 年至 2007 年期间来自已故供体的移植进行回顾性调查。
共确定了 6322 名受者，其中 5306 名接受了来自有心跳已故供体（HBD）的肾脏，1016 名接受了来自心脏死亡后供体（DCD）的肾脏。HBD 的平均 CIT 为 24.0 ± 7.9 小时，DCD 为 21.6 ± 6.7 小时。分别有 12.3%和 50.4%的患者发生延迟肾功能恢复（DGF）（p < 0.001）。原发性无功能（PNF）分别发生在 1.7%和 5.0%的患者中（p < 0.001）。HBD 血清肌酐在三个月后为 166 μM，DCD 为 213 μM（p < 0.001）。HBD 和 DCD 的 5 年移植物存活率分别为 79.5%和 78.3%（p = ns）。多变量分析显示，CIT 是 DGF 和 PNF 的独立危险因素。CIT 较短与两组移植物存活率的提高相关，风险比为 1.024（95%CI：1.011-1.037）/h。在 HBD 中，CIT<20 小时与 5 年时移植物存活率提高 3%相关，而在 DCD 中，CIT<16 小时与移植物存活率提高 10%相关。
较长的 CIT 与荷兰 DGF、PNF 和移植物存活率降低有关。
