Hau Hans Michael, Tautenhahn Hans-Michael, Uhlmann Dirk, Schmelzle Moritz, Morgul Mehmet Haluk, Schoenberg Markus Bo, Krenzien Felix, Jonas Sven, Bartels Michael
From the Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Germany.
Exp Clin Transplant. 2014 Aug;12(4):351-6.
Because of the shortage of available organs for transplants, graft allocation polices have been modified recently. This report deals with the effect of using organs after rescue allocation for pancreas transplant in a single center in the Eurotransplant Region to possibly expand the donor pool.
A retrospective analysis was performed. Between 2007 and 2010, thirty-one pancreas transplants were performed at the University Hospital of Leipzig, in Leipzig, Germany. Among these, 7 cases used rescue organs. These organs had been officially offered to, but rejected by, at least 3 consecutive transplant centers. Donor/recipient and clinical/laboratory transplant/posttransplant outcomes from patients receiving rescue organs were collected and were compared with organs from conventional donors.
Mean donor age was greater in the rescue organ group than in the conventional donor group (28.3 ± 10.7 y vs 23.0 ± 12.5 y). During follow-up (2.3 ± 0.6 y rescue organ group vs 3.9 ± 1.2 y conventional donor group), patient, kidney, and pancreas graft survival rates were 85% in all 3 categories in the rescue organ group, whereas outcomes for conventional donors were 88%, 85%, and 83%. Incidences of pancreatic graft thrombosis, delayed graft function, acute and late rejection episodes (eg, perioperative complications) were comparable between groups. No differences existed between mean serum urea levels and mean HbA1c levels between groups 2 years after transplant. Whereas 2 years after surgery, mean serum creatinine levels (rescue organ group, 78.8 ± 21.0 μmol/L vs 114.3 ± 28.4 μmol/L in the conventional donor group) showed significant differences between groups.
Results are promising. Further pro-spective studies are warranted to evaluate routine transplant of organs after rescue allocation.
由于可用于移植的器官短缺,移植分配政策最近已有所调整。本报告探讨了在欧洲移植区域的一个单一中心,将救援分配后的器官用于胰腺移植可能扩大供体库的效果。
进行回顾性分析。2007年至2010年期间,德国莱比锡大学医院进行了31例胰腺移植。其中,7例使用了救援器官。这些器官已被正式提供给至少3个连续的移植中心,但均被拒绝。收集接受救援器官患者的供体/受体以及临床/实验室移植/移植后结果,并与传统供体的器官进行比较。
救援器官组的供体平均年龄大于传统供体组(28.3±10.7岁对23.0±12.5岁)。在随访期间(救援器官组为2.3±0.6年,传统供体组为3.9±1.2年),救援器官组患者、肾脏和胰腺移植存活率在所有3类中均为85%,而传统供体的结果分别为88%、85%和83%。两组之间胰腺移植血栓形成、移植功能延迟、急性和晚期排斥反应(如围手术期并发症)的发生率相当。移植后2年,两组之间的平均血清尿素水平和平均糖化血红蛋白水平无差异。而术后2年,平均血清肌酐水平(救援器官组为78.8±21.0μmol/L,传统供体组为114.3±28.4μmol/L)在两组之间存在显著差异。
结果令人鼓舞。有必要进行进一步的前瞻性研究,以评估救援分配后器官的常规移植情况。