1 Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom. 2 Department of Histopathology, Guy's Hospital, London, United Kingdom. 3 Department of Surgery University of Cambridge, Cambridge, United Kingdom. 4 NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, United Kingdom.
Transplantation. 2017 Jul;101(7):1698-1703. doi: 10.1097/TP.0000000000001542.
A significant proportion of procured deceased donor kidneys are subsequently discarded. The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012, enabling kidneys at risk of discard to be simultaneously offered to participating centers. We undertook an analysis of discarded kidneys to determine if unnecessary organ discard was still occurring since the KFTS was introduced.
Between April and June 2015, senior surgeons independently inspected 31 consecutive discarded kidneys from throughout the United Kingdom. All kidneys were biopsied. Organs were categorized as usable, possibly usable pending histology, or not usable for implantation. After histology reports were available, final assessments of usability were made.
There were 19 donors (6 donations after brain death, 13 donations after circulatory death), with a median (range) donor age of 67 (29-83) years and Kidney Donor Profile Index of 93 (19-100). Reasons for discard were variable. Only 3 discarded kidneys had not entered the KFTS. After initial assessment postdiscard, 11 kidneys were assessed as usable, with 9 kidneys thought to be possibly usable. Consideration of histological data reduced the number of kidneys thought usable to 10 (10/31; 32%).
The KFTS scheme is successfully identifying organs at high risk of discard, though potentially transplantable organs are still being discarded. Analyses of discarded organs are essential to identify barriers to organ utilization and develop strategies to reduce unnecessary discard.
相当一部分获取的已故供体肾脏随后被丢弃。英国肾脏快速通道计划（KFTS）于 2012 年推出，使有丢弃风险的肾脏能够同时提供给参与的中心。我们对丢弃的肾脏进行了分析，以确定自 KFTS 推出以来是否仍有不必要的器官丢弃。
在 2015 年 4 月至 6 月期间，高级外科医生对来自英国各地的 31 个连续丢弃的肾脏进行了独立检查。所有肾脏均进行了活检。器官分为可使用、可能在等待组织学检查时可使用或不可用于植入。在组织学报告可用后，对可用性进行了最终评估。
有 19 名供者（脑死亡后 6 名，循环死亡后 13 名），中位（范围）供者年龄为 67 岁（29-83 岁），肾脏供者评分指数为 93（19-100）。丢弃的原因各不相同。只有 3 个丢弃的肾脏未进入 KFTS。丢弃后初始评估后，有 11 个肾脏被评估为可使用，其中 9 个肾脏被认为可能可使用。考虑到组织学数据，认为可使用的肾脏数量减少到 10 个（31 个中的 10 个；32%）。
KFTS 计划成功地识别了高丢弃风险的器官，尽管仍有潜在可移植的器官被丢弃。对丢弃器官的分析对于识别器官利用的障碍并制定减少不必要丢弃的策略至关重要。
