Hwang J K, Park S C, Kwon K H, Choi B S, Kim J I, Yang C W, Kim Y S, Moon I S
Department of Surgery, Daejeon St. Mary's Hospital.
Department of Surgery, Uijeongbu St. Mary's Hospital.
Transplant Proc. 2014;46(2):431-6. doi: 10.1016/j.transproceed.2013.11.061.
Our objective was to compare the clinical outcomes of adult kidney transplants from expanded criteria deceased donors (ECD) with those from concurrent standard criteria deceased donors (SCD). Between January 2000 and December 2011, we transplanted 195 deceased donor renal transplants into adult recipients, including 31 grafts (15.9%) from ECDs and 164 grafts (84.1%) from SCDs. ECDs were classified using the United Network for Organ Sharing (UNOS) definitions. Donor and recipient risk factors were analyzed separately and their correlation with recipient graft function and survival was evaluated (minimum 6-month follow-up). ECDs were older (56.8 ± 6.3 years), showed an increased incidence of hypertension, diabetes, and cerebrovascular brain death, and had a higher preretrieval serum creatinine level than SCDs. ECD kidney recipients had a shorter waiting time (P = .019) but other baseline characteristics (age, gender, body mass index [BMI], cause of end-stage renal disease, type of renal replacement therapy, incidence of diabetes and hypertension, number of HLA antigen mismatches, positivity for panel-reactive antigen, and cold ischemic time) were not significantly different from those of SCD kidney recipients. Mean glomerular filtration rate (GFR) at 1 month, 6 months, 1 year, and 3 years after transplantation was significantly lower in recipients of ECD transplants than recipients of SCD transplants, but the GFR level at 5 and 10 years was not significantly different between ECD and SCD recipient groups (P = .134 and .702, respectively). Incidence of acute rejection episodes and surgical complications did not differ significantly between the 2 recipient groups, but the incidence of delayed graft function (DGF) and infectious complications was higher in ECD kidney recipients than SCD kidney recipients (P = .007 and P = .008, respectively). Actual patient and graft survival rates were similar between the 2 recipient groups with a mean follow-up of 43 months. There were no significant differences in graft survival (P = .111) or patient survival (P = .562) between the 2 groups. Although intermediate-term renal function followed longitudinally was better in SCD kidney recipients, graft and patient survival of ECD kidney recipients were comparable with those of SCD kidney recipients. In conclusion, use of renal grafts from ECDs is a feasible approach to address the critical organ shortage.
我们的目标是比较扩大标准死亡供体（ECD）的成人肾移植与同期标准标准死亡供体（SCD）的成人肾移植的临床结果。2000年1月至2011年12月期间，我们将195例死亡供体肾移植给成年受者，其中包括31例（15.9%）来自ECD的移植物和164例（84.1%）来自SCD的移植物。ECD根据器官共享联合网络（UNOS）的定义进行分类。分别分析供体和受体的风险因素，并评估它们与受体移植物功能和生存的相关性（至少随访6个月）。ECD年龄较大（56.8±6.3岁），高血压、糖尿病和脑血管性脑死亡的发生率增加，且术前血清肌酐水平高于SCD。ECD肾移植受者的等待时间较短（P = 0.019），但其他基线特征（年龄、性别、体重指数[BMI]、终末期肾病病因、肾脏替代治疗类型、糖尿病和高血压发生率、HLA抗原错配数、群体反应性抗体阳性率和冷缺血时间）与SCD肾移植受者无显著差异。移植后1个月、6个月、1年和3年时，ECD移植受者的平均肾小球滤过率（GFR）显著低于SCD移植受者，但ECD和SCD受体组在5年和10年时的GFR水平无显著差异（分别为P = 0.134和0.702）。两个受体组之间急性排斥反应发作和手术并发症的发生率无显著差异，但ECD肾移植受者的移植肾功能延迟（DGF）和感染并发症的发生率高于SCD肾移植受者（分别为P = 0.007和P = 0.008）。两组受体的实际患者和移植物存活率相似，平均随访43个月。两组之间的移植物存活率（P = 0.111）或患者存活率（P = 0.562）无显著差异。尽管纵向观察SCD肾移植受者的中期肾功能较好，但ECD肾移植受者的移植物和患者存活率与SCD肾移植受者相当。总之，使用ECD的肾移植物是解决关键器官短缺的一种可行方法。
