Kleinert R, Wahba R, Heiermann N, Kisner T, Hos N, Stippel D L
Department of General, Visceral, and Cancer Surgery, Transplant Center Cologne, University of Cologne, Cologne, Germany.
Transplant Proc. 2013 Jan-Feb;45(1):95-8. doi: 10.1016/j.transproceed.2012.08.011.
Dialysis is the standard bridging method for patients with end-stage renal disease. In rare cases, dialysis is impossible and immediate kidney transplantation (KT) is the only option for survival. Most allocation organizations offer an immediate allocation procedure (high urgency [HU]), which focuses on immediate allocation at the cost of immunologic matching. The impossibility of dialysis is mainly caused by multiple systemic thromboses and blood stream infections. This situation creates an ethical dilemma: Accepting the HU-KT allocation potentially saves the patient's life albeit with negatively effects on the expected patient and organ survivals. In times of organ shortage, more information is needed regarding this difficult decision; the published literature is limited to 4 papers.
We performed a retrospective analysis of patients who were transplanted by HU allocation in our center between January 1989 and October 2010.
Of 1040 KT, 10 (0.96%) were performed in HU condition. Mean follow-up time was 37 months. The main reason for HU-KT was exhaustion of vascular access in combination with a bloodstream infection. All recipients showed severe preoperative comorbidities. Patient survival was 90% at 1, 80% at 3, and 60% at 5 years. There was 1 graft loss owing to chronic rejection.
When kidney transplantation is performed as an HU procedure, it is associated with a greater morbidity and mortality compared with elective cases. Bloodstream infections that existed before transplantation contributed considerably to mortality.
透析是终末期肾病患者的标准过渡治疗方法。在极少数情况下，无法进行透析，立即进行肾移植（KT）是生存的唯一选择。大多数分配组织提供立即分配程序（高紧迫性[HU]），该程序侧重于立即分配，但以牺牲免疫匹配为代价。无法进行透析主要是由多发性全身血栓形成和血流感染引起的。这种情况引发了一个伦理困境：接受HU-KT分配可能挽救患者生命，尽管对患者和器官的预期存活有负面影响。在器官短缺时期，对于这个艰难的决定需要更多信息；已发表的文献仅限于4篇论文。
我们对1989年1月至2010年10月在我们中心通过HU分配进行移植的患者进行了回顾性分析。
在1040例KT中，10例（0.96%）是在HU条件下进行的。平均随访时间为37个月。HU-KT的主要原因是血管通路耗竭合并血流感染。所有受者术前均有严重合并症。患者1年生存率为90%，3年生存率为80%，5年生存率为60%。有1例移植物因慢性排斥反应而丢失。
当作为HU程序进行肾移植时，与择期病例相比，其发病率和死亡率更高。移植前存在的血流感染对死亡率有很大影响。
