Patel M S, Niemann C U, Sally M B, De La Cruz S, Zatarain J, Ewing T, Crutchfield M, Enestvedt C K, Malinoski D J
Department of Surgery, Massachusetts General Hospital, Boston, MA.
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.
Am J Transplant. 2015 Aug;15(8):2152-8. doi: 10.1111/ajt.13263. Epub 2015 Apr 22.
Our objective was to evaluate the impact of hydroxyethyl starch (HES) use in organ donors after neurologic determination of death (DNDD) on recipient renal graft outcomes. The following data elements were prospectively collected for every DNDD managed by a single organ procurement organization from June 2011 to July 2013: demographics; critical care endpoints; treatments, including the use of HES; graft cold ischemia time (CIT); and the occurrence of recipient delayed graft function (DGF, dialysis in the first week after transplantation). Logistic regression was performed to identify independent predictors of DGF with a p-value <0.05. The results were then adjusted for each donor's calculated propensity to receive HES. Nine hundred eighty-six kidneys were transplanted from 529 donors. Forty-two percent received HES (1217 ± 528 mL) and 35% developed DGF. Kidneys from DNDDs who received HES had a higher crude rate of DGF (41% vs. 31%, p < 0.001). After accounting for the propensity to receive HES, independent predictors of DGF were age (OR 1.02 [1.01-1.04] per year), CIT (OR 1.04[1.02-1.06] per hour), creatinine (OR 1.5 [1.32-1.72] per mg/dL) and HES use (OR 1.41 [1.02-1.95]). HES use during donor management was independently associated with a 41% increase in the risk of DGF in kidney transplant recipients.
我们的目标是评估在经神经学判定死亡（DNDD）后的器官捐献者中使用羟乙基淀粉（HES）对接受者肾移植结果的影响。2011年6月至2013年7月，由一个单一器官获取组织管理的每例DNDD均前瞻性收集了以下数据元素：人口统计学资料；重症监护终点；治疗情况，包括HES的使用；移植肾冷缺血时间（CIT）；以及接受者延迟移植肾功能恢复（DGF，移植后第一周内进行透析）的发生情况。进行逻辑回归以确定p值<0.05的DGF独立预测因素。然后针对每个捐献者计算的接受HES的倾向对结果进行调整。从529名捐献者处移植了986个肾脏。42%的捐献者接受了HES（1217±528mL），35%发生了DGF。接受HES的DNDD捐献的肾脏DGF粗发生率更高（41%对31%，p< 0.001）。在考虑接受HES的倾向后，DGF的独立预测因素为年龄（每年OR 1.02[1.01 - 1.04]）、CIT（每小时OR 1.04[1.02 - 1.06]）、肌酐（每mg/dL OR 1.5[1.32 - 1.72]）和HES的使用（OR 1.41[1.02 - 1.95]）。在供体管理期间使用HES与肾移植受者发生DGF的风险独立增加41%相关。
