Marlais Matko, Pankhurst Laura, Hudson Alex, Sharif Khalid, Marks Stephen D
1 Institute of Child Health, University College London, London, United Kingdom. 2 NHS Blood and Transplant, Bristol, United Kingdom. 3 Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom. 4 Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Transplantation. 2017 Jun;101(6):1177-1181. doi: 10.1097/TP.0000000000001264.
Donation after circulatory death (DCD) kidney transplantation has acceptable renal allograft survival in adults but there are few data in pediatric recipients. The aim of this study was to determine renal allograft outcomes for pediatric recipients of a DCD kidney.
Data were collected from the UK Transplant Registry held by National Health Service Blood and Transplant. Kidney transplants performed for pediatric recipients (age, <18 years) in the United Kingdom from 2000 to 2014 were separated into DCD, donation after brain death (DBD), and living donor (LD) transplants, analyzing 3-year patient and renal allograft survival.
One thousand seven hundred seventy-two kidney only transplants were analyzed. Twenty-one (1.2%) of these were from DCD donors, 955 (53.9%) from DBD donors, and 796 (44.9%) from LDs. Patient survival is 100% in the DCD group, 98.7% in the DBD group, and 98.9% in the LD group. Three-year renal allograft survival was 95.2% in the DCD group, 87.1% in the DBD group, and 92.9% in the LD group. There was no significant difference in 3-year renal allograft survival between the DCD and DBD groups (P = 0.42) or DCD and LD groups (P = 0.84). For DCD, the primary nonfunction rate was 5% and delayed graft function was 25%.
Children receiving a DCD kidney transplant have good renal allograft survival at 3-year follow-up, comparable to those receiving a kidney from a DBD donor or a LD. This limited evidence encourages the use of selected DCD kidneys in pediatric transplantation, and DCD allocation algorithms may need to be reviewed in view of this.
心脏死亡后器官捐献（DCD）肾移植在成人中具有可接受的肾移植存活率，但儿科受者的数据较少。本研究的目的是确定DCD肾移植儿科受者的肾移植结局。
数据收集自英国国民医疗服务体系血液与移植部门持有的英国移植登记处。将2000年至2014年在英国为儿科受者（年龄<18岁）进行的肾移植分为DCD、脑死亡后器官捐献（DBD）和活体供肾（LD）移植，分析3年患者和肾移植存活率。
共分析了1772例单纯肾移植。其中21例（1.2%）来自DCD供者，955例（53.9%）来自DBD供者，796例（44.9%）来自活体供者。DCD组患者存活率为100%，DBD组为98.7%，LD组为98.9%。DCD组3年肾移植存活率为95.2%，DBD组为87.1%，LD组为92.9%。DCD组与DBD组之间（P = 0.42）或DCD组与LD组之间（P = 0.84）的3年肾移植存活率无显著差异。对于DCD，原发性无功能率为5%，移植肾功能延迟率为25%。
接受DCD肾移植的儿童在3年随访时具有良好的肾移植存活率，与接受DBD供者或活体供者肾脏的儿童相当。这一有限的证据鼓励在儿科移植中使用经过挑选的DCD肾脏，鉴于此，可能需要对DCD分配算法进行审查。
