Carrier M, Lizé J F
Medical Direction of Transplant Quebec, Québec, Canada.
Transplant Proc. 2012 Sep;44(7):2227-30. doi: 10.1016/j.transproceed.2012.07.120.
Age and comorbidities of brain-dead donors have increased throughout the last decade. The use of expanded criteria donors (ECD) has become a common clinical practice. The objective of the present study was to compare outcomes of patients who underwent kidney transplantation from ECD versus standard criteria donors (SCD).
We studied 1375 adult recipients of kidney transplantations from 792 deceased donors in six Quebec centers between 2003 and 2009. Patient and graft survivals were analyzed using uni- and multivariate methods in regard to the effects of donor and recipient characteristics. ECD were defined per United Network for Organ Sharing: criteria age >60 years of age or age 50 to 59 years with two of three associated risk factors-history of cerebrovascular accident, hypertension, or elevated serum creatinine Mean follow-up was 3.5 ± 2 years.
Among the 792 donors, 510 SCD (64%) and 282 ECD (36%) were used for 1375 kidney transplant recipients. ECD had no effect on patient (P = .47) or graft (P = .28) survival. Cox proportional hazards regression analysis showed female donors (relative risk [RR] 1.75, P = .008), recipient age (RR 1.07, P = .0001), and waiting time be for transplantation (RR 1.000, P = .0001) to be associated with a greater risk of death after transplantation. Donor (RR 1.018, P = .0099) and recipient (RR 1.013, P = .0387) age and recipient waiting time for transplantation (RR 1.000, P = .0048) were also associated with a greater risk of graft loss.
The use of SCD or ECD had no impact on patient or graft survival after kidney transplantation. Donor and recipient ages as well as waiting time for transplantation were related to graft loss. Waiting time remains a significant factor affecting outcomes; efforts should aim to decrease this period.
在过去十年中，脑死亡供者的年龄和合并症有所增加。扩大标准供者（ECD）的使用已成为一种常见的临床做法。本研究的目的是比较接受ECD供肾移植与标准标准供者（SCD）供肾移植患者的结局。
我们研究了2003年至2009年期间魁北克六个中心792名已故供者的1375例成年肾移植受者。使用单变量和多变量方法分析患者和移植物的存活率，以了解供者和受者特征的影响。ECD根据器官共享联合网络定义：标准年龄>60岁或50至59岁且具有三个相关危险因素中的两个——脑血管意外病史、高血压或血清肌酐升高。平均随访时间为3.5±2年。
在792名供者中，510名SCD（64%）和282名ECD（36%）用于1375例肾移植受者。ECD对患者（P = 0.47）或移植物（P = 0.28）存活率没有影响。Cox比例风险回归分析显示女性供者（相对风险[RR]1.75，P = 0.008）、受者年龄（RR 1.07，P = 0.0001）和移植等待时间（RR 1.000，P = 0.0001）与移植后死亡风险增加相关。供者（RR 1.018，P = 0.0099）和受者（RR 1.013，P = 0.0387）年龄以及受者移植等待时间（RR 1.000，P = 0.0048）也与移植物丢失风险增加相关。
SCD或ECD的使用对肾移植后患者或移植物存活率没有影响。供者和受者年龄以及移植等待时间与移植物丢失有关。等待时间仍然是影响结局的重要因素；应努力缩短这一时期。
