Jeong J C, Kim M G, Ro H, Kim Y J, Park H C, Kwon H Y, Jeon H J, Ha J, Ahn C, Yang J
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Transplant Proc. 2012 May;44(4):843-7. doi: 10.1016/j.transproceed.2012.01.102.
Potential deceased donor management optimization is important for organ recovery maximization. Before optimization, the current state of donor management and predictors for organ recovery require analysis.
We retrospectively analyzed organ procurement activity and medical management for 2005 to 2010 potential brain death donors at Seoul National University Hospital.
Of 316 contacts for potential brain-dead donors, 129 (39.7%) patients were transferred to the donor management team. Among the causes of transfer failure, issues related to proper donor management affected 33%. Expanded criteria donors were 17.9% of transferred donors. Organ recovery was successful in 111 (90.2%) donors. A total of 360 organs were recovered, corresponding to a mean of 2.92 ± 1.37 organs per donor. The absence of organ demand was an important cause of recovery failure among less transplanted organs. Brain death-related complications were identified as follows: acute kidney injury (AKI), defined by AKI network criteria, occurred in 19 (15.4%); cardiopulmonary resuscitation in 5 (3.1%); bacteremia in 12 (9.7%); thrombocytopenia in 24 (19.5%); and diabetes insipidus in 42 (34.1%). AKI was a significant independent risk factor for organ recovery failure in both the liver and kidney (odds ratio [OR] 0.147, 95% confidence interval [0.045, 0.473], P = .001; OR 0.096, 95% confidence interval [0.023, 0.392], P = .001, for kidney and liver, respectively).
Both the transfer success rate and rate of organs transplanted per donor of potential deceased donors remained low in Korea. AKI during potential donor management was a risk factor for kidney and liver recovery failure.
优化潜在的已故供体管理对于最大化器官获取至关重要。在进行优化之前，需要分析供体管理的当前状态以及器官获取的预测因素。
我们回顾性分析了首尔国立大学医院2005年至2010年潜在脑死亡供体的器官获取活动和医疗管理情况。
在316例潜在脑死亡供体接触中，129例（39.7%）患者被转至供体管理团队。在转介失败的原因中，与供体妥善管理相关的问题占33%。扩大标准供体占转介供体的17.9%。111例（90.2%）供体的器官获取成功。共获取360个器官，平均每位供体获取2.92±1.37个器官。器官需求不足是较少移植器官获取失败的重要原因。确定的脑死亡相关并发症如下：根据急性肾损伤网络标准定义的急性肾损伤（AKI）发生在19例（15.4%）；心肺复苏5例（3.1%）；菌血症12例（9.7%）；血小板减少症24例（19.5%）；尿崩症42例（34.1%）。AKI是肝脏和肾脏器官获取失败的显著独立危险因素（肾脏的比值比[OR]为0.147，95%置信区间[0.045，0.473]，P = 0.001；肝脏的OR为0.096，95%置信区间[0.023，0.392]，P = 0.001）。
在韩国，潜在已故供体的转介成功率和每位供体的移植器官率仍然较低。潜在供体管理期间的AKI是肾脏和肝脏获取失败的危险因素。
