1 Division of Nephrology, University of British Columbia, Vancouver, Canada. 2 Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada. 3 Department of Urologic Sciences, University of British Columbia, Vancouver, Canada. 4 Tufts-New England Medical Center, Boston, MA. 5 Address correspondence to: Jagbir Gill, M.D., M.P.H., University of British Columbia, St. Paul's Hospital, Providence Building Ward 6a-1081 Burrard Street, Vancouver, BC, Canada V6Z 1YK.
Transplantation. 2014 Mar 27;97(6):668-74. doi: 10.1097/01.TP.0000438637.29214.10.
The role of pulsatile perfusion (PP) across different cold ischemic times (CIT) within different donor groups is unclear. This study examined the association of PP with delayed graft function (DGF) in all (n=94,709) deceased donor kidney transplants in the US between 2000 and 2011, as a function of CIT and donor type.
Using the Scientific Registry of Transplant Recipients data, all adult standard criteria donors (SCD, n=71,192), expanded criteria donors (ECD, n=15,122), and donors after circulatory death (DCD, n=8,395) kidney transplant recipients were identified. Within each donor group, transplants were stratified based on duration of CIT: 0 to 6 hours, 6.1 to 12 hours, 12.1 to 18 hours, 18.1 to 24 hours, 24.1 to 30 hours, 30.1 to 36 hours, and greater than 36 hours. Within each group, the odds of DGF with and without PP was determined after adjusting for donor, recipient, and transplant factors, including a propensity score for the likelihood of PP use, and clustering on transplant center using multivariable logistic regression.
When stratified by donor type and CIT, the adjusted odds of DGF were lower with PP across all CIT in SCD transplants, when CIT was greater than 6 hours in ECD transplants, and when CIT was between 6 and 24 hours in DCD transplants. CIT was independently associated with a greater risk of DGF irrespective of storage method, but this effect was substantially modified by PP.
PP is associated with a reduced risk of DGF irrespective of donor type and CIT. Although PP modifies the impact of CIT on the risk of DGF, it does not eliminate its association with DGF, suggesting the optimal strategy to reduce DGF is to minimize CIT and utilize PP in all deceased donor transplants.
在不同的供体群体中，不同冷缺血时间（CIT）下的脉动灌注（PP）的作用尚不清楚。本研究在美国 2000 年至 2011 年间所有（n=94709）死亡供体肾移植中，作为 CIT 和供体类型的函数，研究了 PP 与延迟移植物功能障碍（DGF）的相关性。
使用 Scientific Registry of Transplant Recipients 数据，确定了所有成人标准标准供体（SCD，n=71192）、扩展标准供体（ECD，n=15122）和循环死亡后供体（DCD，n=8395）肾移植受者。在每个供体组内，根据 CIT 持续时间对移植进行分层：0 至 6 小时、6.1 至 12 小时、12.1 至 18 小时、18.1 至 24 小时、24.1 至 30 小时、30.1 至 36 小时和大于 36 小时。在每个组内，在调整供体、受者和移植因素后，包括使用倾向评分来确定 PP 使用的可能性，并使用多变量逻辑回归对移植中心进行聚类，确定有无 PP 时 DGF 的可能性。
按供体类型和 CIT 分层时，在 SCD 移植中，无论 CIT 如何，PP 在所有 CIT 中均可降低 DGF 的调整后可能性，在 ECD 移植中 CIT 大于 6 小时时，以及在 DCD 移植中 CIT 在 6 至 24 小时之间时。无论存储方法如何，CIT 与 DGF 的风险增加独立相关，但这种影响被 PP 大大改变。
无论供体类型和 CIT 如何，PP 与 DGF 风险降低相关。尽管 PP 改变了 CIT 对 DGF 风险的影响，但并未消除其与 DGF 的关联，这表明减少 DGF 的最佳策略是尽量减少 CIT，并在所有死亡供体移植中使用 PP。
