Martínez-Vaquera S, Navarro Cabello M D, López-Andreu M, Jurado J M Dueñas, Haad C Rodelo, Salas R Ortega, Benot A Rodríguez, Hernández J P Campos, Arista J C Robles, Aljama P
Nephology Unit, University Hospital Reina Sofia, Cordoba, Spain.
Transplant Proc. 2013;45(10):3595-8. doi: 10.1016/j.transproceed.2013.11.003.
Kidney transplantation is the treatment of choice for patients with end-stage renal disease. In recent years donor criteria have changed to increase the percentage of expanded-criteria donors (ECDs). The aim of this study was to analyze transplants from ECDs obtained at our institution from. 2010 to 2012. We studied the comorbidity of ECD, preimplantation histologic study, renal function, and survival of transplanted grafts.
Eighty ECDs (160 kidneys) were analyzed. Forty-nine grafts were not implanted owing to macroscopic lesions (37 kidneys) or histologic findings on preimplantation biopsy (12 kidneys). Finally, 60 grafts from ECDs were implanted in our center. We analyzed the characteristics of the grafts (kidney function, creatinine clearance) and compared the data with a control group of allografts from standard-criteria donors (n = 14).
The median age of the ECD group was 72 years (range 65-77). No differences were found in certain characteristics between the ECDs whose kidneys were or were not implanted (hypertension, diabetes, creatinine at the time of the donation or proteinuria). However, there were differences in donor age (75 vs 67; P = .043), increased preimplantation biopsy score (6.8 ± 1.3 vs 4.8 ± 1.1; P = .041), and a higher percentage of cardiovascular disease (62.5% vs 43%; P = .038). Comparison of ECD and non-ECD grafts showed a lower creatinine clearance at 1 year (50 ± 05 mL/min vs 69 ± 96 mL/min, respectively; P < .001) and 2 years (50 ± 07 mL/min vs 67 ± 74 mL/min; P < .001) after transplantation. There were no differences in delayed graft function or graft survival between the 2 groups at 2 years after transplantation (95% vs 100%; P = .38).
We found no differences in graft survival from ECD compared with the control group of standard-criteria donors. The evaluation of grafts from ECD may be a strategy to increase the number of kidney transplants.
肾移植是终末期肾病患者的首选治疗方法。近年来，供体标准发生了变化，以提高扩大标准供体（ECD）的比例。本研究的目的是分析2010年至2012年在我们机构获取的ECD肾移植情况。我们研究了ECD的合并症、植入前组织学研究、肾功能以及移植肾的存活情况。
分析了80例ECD（160个肾脏）。49个移植物因肉眼可见病变（37个肾脏）或植入前活检的组织学结果（12个肾脏）未植入。最终，60个来自ECD的移植物在我们中心植入。我们分析了移植物的特征（肾功能、肌酐清除率），并将数据与标准标准供体的同种异体移植对照组（n = 14）进行比较。
ECD组的中位年龄为72岁（范围65 - 77岁）。肾脏已植入或未植入的ECD在某些特征方面（高血压、糖尿病、捐赠时的肌酐或蛋白尿）未发现差异。然而，在供体年龄（75岁对67岁；P = 0.043）、植入前活检评分增加（6.8 ± 1.3对4.8 ± 1.1；P = 0.041）以及心血管疾病百分比更高（62.5%对43%；P = 0.038）方面存在差异。ECD与非ECD移植物比较显示，移植后1年（分别为50 ± 5 mL/分钟对69 ± 9.6 mL/分钟；P < 0.001）和2年（50 ± 7 mL/分钟对67 ± 7.4 mL/分钟；P < 0.001）时肌酐清除率较低。移植后2年，两组在移植肾功能延迟或移植物存活方面无差异（95%对100%；P = 0.38）。
我们发现与标准标准供体对照组相比，ECD的移植物存活无差异。评估ECD的移植物可能是增加肾移植数量的一种策略。
