Benck Urs, Schnuelle Peter, Krüger Bernd, Nowak Kai, Riester Thomas, Mundt Heiko, Lutz Niklas, Jung Matthias, Birck Rainer, Krämer Bernhard K, Schmitt Wilhelm H
Vth Department of Medicine (Nephrology, Endocrinology, Rheumatology), Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Medical Faculty Mannheim, Renal Transplant Center, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Int Urol Nephrol. 2015 Dec;47(12):2039-46. doi: 10.1007/s11255-015-1127-5. Epub 2015 Oct 26.
Whether organs from donors after brain death (DBD) with acute kidney injury (AKI) should be accepted for transplantation is still a matter of debate.
This was a retrospective, center-based, matched cohort study of 33 renal transplant patients who received a renal allograft from a DBD with AKI. Sixty-five kidney transplants without donor AKI transplanted directly before and after the index transplantation served as controls.
All AKI donors were classified according to RIFLE criteria: 9.1 % Risk, 54.6 % Injury, and 36.4 % Failure. Mean serum creatinine was 2.41 ± 0.88 mg/dL at procurement and 1.06 ± 0.32 mg/dL on admission. AKI donors had lower 24-h urine production (3.22 ± 1.95 vs. 4.59 ± 2.53 L, p = 0.009) and received more frequently noradrenaline (93.9 vs. 72.3 %, p = 0.02) and/or adrenaline (15.2 vs. 1.5 %, p = 0.02). Recipient and transplant characteristics were similar except a more favorable HLA match in control patients (p = 0.01). Hemodialysis posttransplant was more frequently used in AKI recipients (14/33 [42.4 %] vs. 18/65 [27.7 %], p = 0.17). While significant elevations in serum creatinine were noted in these patients until 10 days after transplantation, this difference lost statistical significance by day 14. One-year graft survival was very similar when comparing the groups (93.6 % [95 % CI 76.8-98.4 %] vs. 90.3 % [95 % CI 79.6-95.5 %], log rank p = 0.58).
Kidneys from AKI donors can be transplanted with excellent intermediate prognosis and should not be discarded.
脑死亡（DBD）后伴有急性肾损伤（AKI）的供体器官是否应被接受用于移植仍存在争议。
这是一项基于中心的回顾性匹配队列研究，纳入了33例接受来自伴有AKI的DBD供体肾脏移植的肾移植患者。在索引移植前后直接进行的65例无供体AKI的肾脏移植作为对照。
所有AKI供体均根据RIFLE标准进行分类：风险期9.1%，损伤期54.6%，衰竭期36.4%。获取时平均血清肌酐为2.41±0.88mg/dL，入院时为1.06±0.32mg/dL。AKI供体的24小时尿量较低（3.22±1.95 vs. 4.59±2.53L，p = 0.009），更频繁地接受去甲肾上腺素（93.9% vs. 72.3%，p = 0.02）和/或肾上腺素（15.2% vs. 1.5%，p = 0.02）。除了对照患者的HLA匹配更有利（p = 0.01）外，受体和移植特征相似。AKI受体更频繁地使用移植后血液透析（14/33 [42.4%] vs. 18/65 [27.7%]，p = 0.17）。虽然这些患者在移植后10天内血清肌酐显著升高，但到第14天时这种差异失去统计学意义。比较两组时，1年移植肾存活率非常相似（93.6% [95%CI 76.8 - 98.4%] vs. 90.3% [95%CI 79.6 - 95.5%]，对数秩检验p = 0.58）。
来自AKI供体的肾脏可以进行移植，中期预后良好，不应被丢弃。
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