循环死亡后捐赠者肾移植中冷缺血时间的影响
Impact of Cold Ischemia Time in Kidney Transplants From Donation After Circulatory Death Donors.
作者信息
Kayler Liise, Yu Xia, Cortes Carlos, Lubetzky Michelle, Friedmann Patricia
机构信息
Department of Surgery, Erie County Medical Center, Buffalo, NY.
Department of Surgery, Montefiore Medical Center, Bronx, NY.
出版信息
Transplant Direct. 2017 Jun 23;3(7):e177. doi: 10.1097/TXD.0000000000000680. eCollection 2017 Jul.
BACKGROUND
Deceased-donor kidneys are exposed to ischemic events from donor instability during the process of donation after circulatory death (DCD). Clinicians may be reluctant to transplant DCD kidneys with prolonged cold ischemia time (CIT) for fear of an additional deleterious effect.
METHODS
We performed a retrospective cohort study examining US registry data between 1998 and 2013 of adult first-time kidney-only recipients of paired kidneys (derived from the same donor transplanted into different recipients) from DCD donors.
RESULTS
On multivariable analysis, death-censored graft survival (DCGS) was comparable between recipients of kidneys with higher CIT relative to paired donor recipients with lower CIT when the CIT difference was 1 hour or longer (adjusted hazard ratio, [aHR], 1.02; 95% confidence interval [CI], 0.88-1.17; n = 6276), 5 hours or longer (aHR, 0.98; 95% CI, 0.80-1.19; n = 3130), 10 hours or longer (aHR, 1.15; 95% CI, 0.82-1.60; n = 1124) or 15 hours (aHR, 1.15; 95% CI, 0.66-1.99; n = 498). There was a higher rate of primary non function in the long CIT groups for delta 1 hour or longer (0.89% vs 1.63%; = 0.006), 5 hours (1.09% vs 1.67%, = 0.13); 10 hours (0.53% vs 1.78%; = 0.03), and 15 hours (0.40% vs 1.61%; = 0.18), respectively. Between each of the 4 delta CIT levels of shorter and longer CIT, there was a significantly and incrementally higher rate of delayed graft function in the long CIT groups for delta 1 hour or longer (37.3% vs 41.7%; < 0.001), 5 hours (35.9% vs 42.7%; < 0.001), 10 hours (29.4% vs 44.2%, < 0.001), and 15 hours (29.6% vs 46.1%, < 0.001), respectively. Overall patient survival was comparable with delta CITs of 1 hour or longer (aHR, 0.96; 95% CI, 0.84-1.08), 5 hours (aHR, 1.01; 95% CI, 0.85-1.20), and 15 hours (aHR, 1.27; 95% CI, 0.79-2.06) but not 10 hours (aHR, 1.47; 95% CI, 1.09-1.98).
CONCLUSIONS
These results suggest that in the setting of a prior ischemic donor event, prolonged CIT has limited bearing on long-term outcomes.
背景
在循环死亡后器官捐献（DCD）过程中，已故供体的肾脏会因供体不稳定而遭受缺血事件。临床医生可能因担心额外的有害影响而不愿移植冷缺血时间（CIT）延长的DCD肾脏。
方法
我们进行了一项回顾性队列研究，分析了1998年至2013年美国登记数据中，成年首次仅接受肾脏移植的成对肾脏（来自同一供体移植给不同受者）的DCD供体受者情况。
结果
多变量分析显示，当CIT差异为1小时或更长时（调整风险比[aHR]，1.02；95%置信区间[CI]，0.88 - 1.17；n = 6276）、5小时或更长时（aHR，0.98；95% CI，0.80 - 1.19；n = 3130）、10小时或更长时（aHR，1.15；95% CI，0.82 - 1.60；n = 1124）或15小时时（aHR，1.15；95% CI，0.66 - 1.99；n = 498），与CIT较低的成对供体受者相比，CIT较高的肾脏受者的死亡删失移植物存活率（DCGS）相当。在CIT差异为1小时或更长（0.89%对1.63%；P = 0.006）、5小时（1.09%对1.67%，P = 0.13）、10小时（0.53%对1.78%；P = 0.03）和15小时（0.40%对1.61%；P = 0.18）的长CIT组中，原发性无功能发生率较高。在4个较短和较长CIT差异水平中的每一个之间，长CIT组中延迟移植物功能发生率在CIT差异为1小时或更长时（37.3%对41.7%；P < 0.001）、5小时（35.9%对42.7%；P < 0.001）、10小时（29.4%对44.2%，P < 0.001）和15小时（29.6%对46.1%，P < 0.001）时显著且逐渐升高。总体患者生存率在CIT差异为1小时或更长时（aHR，0.96；95% CI，0.84 - 1.08）、5小时（aHR，1.01；95% CI，0.85 - 1.20）和15小时（aHR，1.27；95% CI，0.79 - 2.06）时相当，但在10小时时（aHR，1.47；95% CI，1.09 - 1.98）并非如此。
结论
这些结果表明，在先前存在缺血供体事件的情况下，延长的CIT对长期结局影响有限。
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