Anderson Patrick T, Aquil Shahid, McLean Kelly, McAlister Vivian C, Sener Alp, Luke Patrick P
From the Department of Surgery, Division of Urology, The Ottawa Hospital, University of Ottawa, Ottawa, Ont. (Anderson); the Western University Schulich School of Medicine and Dentistry, London, Ont. (McAlister, Sener, Luke); the Department of Surgery, Western University, London, Ont. (Aquil, McLean, McAlister, Sener, Luke); and the Multi-Organ Transplant Program, London Health Sciences Centre, London, Ont. (Aquil, McLean, McAlister, Sener, Luke).
Can J Surg. 2017 Sep;60(5):323-328. doi: 10.1503/cjs.011315.
Compared with neurologic determination of death (NDD) donor organs, donation after cardiac death (DCD) donor organs have traditionally been considered of inferior quality owing to warm ischemia experienced during procurement. We present, to our knowledge, the first analysis of simultaneous pancreas and kidney (SPK) transplants using DCD donor organs in Canada.
We carried out a retrospective cohort study of SPK transplants from 13 DCD and 68 NDD donors performed between October 2008 and July 2016. In all patients immunosuppression was induced with thymoglobulin and continued with tacrolimus, mycophenolate mofetil and prednisone maintenance therapy.
Donor and recipient characteristics of DCD and NDD groups were similar with respect to age, sex, body mass index, kidney and pancreas cold ischemia times, and donor terminal creatinine. Mean DCD graft warm ischemia time was 0.5 (range 0.4-0.7) hours. Median follow-up was 2.2 (range 0.1-6.7) years and 2.7 (range 0.3-6.3) years for the DCD and NDD groups, respectively. The DCD and NDD groups were similar with regards to recipient percent panel reactive antibody and presence of human leukocyte antigen antibodies. The groups also received similar total doses of thymoglobulin. In total 38% of patients in the DCD group experienced renal delayed graft function (DGF) compared with 10% in the NDD group ( = 0.027). There were 7 cases of pancreas graft thrombosis requiring relaparotomy in the NDD group compared with none in the DCD group. No patients from either group required insulin at any time after transplant. Although the estimated glomerular filtration rate (eGFR) was lower in the DCD than the NDD group on postoperative days 7 and 14 ( = 0.025), no difference was noted on day 30 or through 4 years after transplant. No differences were seen between the groups with respect to amylase, lipase, or glycosated hemoglobin (HbA) up to 4 years after transplant, or in kidney, pancreas, or patient survival at any time after transplant.
Our results show that, apart from a higher renal DGF rate, SPK transplants with DCD donor organs have comparable outcomes to standard transplants with NDD donor organs.
与脑死亡判定（NDD）供体器官相比，心脏死亡后捐献（DCD）供体器官传统上被认为质量较差，因为获取过程中会经历热缺血。据我们所知，我们首次对加拿大使用DCD供体器官进行的胰肾联合移植（SPK）进行了分析。
我们对2008年10月至2016年7月期间进行的13例DCD供体和68例NDD供体的SPK移植进行了回顾性队列研究。所有患者均用抗胸腺细胞球蛋白诱导免疫抑制，并继续使用他克莫司、霉酚酸酯和泼尼松维持治疗。
DCD组和NDD组的供体和受体特征在年龄、性别、体重指数、肾脏和胰腺冷缺血时间以及供体终末期肌酐方面相似。DCD移植物平均热缺血时间为0.5（范围0.4 - 0.7）小时。DCD组和NDD组的中位随访时间分别为2.2（范围0.1 - 6.7）年和2.7（范围0.3 - 6.3）年。DCD组和NDD组在受体群体反应性抗体百分比和人类白细胞抗原抗体存在情况方面相似。两组接受的抗胸腺细胞球蛋白总剂量也相似。DCD组共有38%的患者发生肾移植延迟功能恢复（DGF），而NDD组为10%（P = 0.027）。NDD组有7例胰腺移植物血栓形成需要再次剖腹手术，而DCD组无此情况。两组患者移植后任何时间均无需胰岛素治疗。尽管术后第7天和第14天DCD组的估计肾小球滤过率（eGFR）低于NDD组（P = 0.025），但移植后第30天或4年内未发现差异。移植后4年内，两组在淀粉酶、脂肪酶或糖化血红蛋白（HbA）方面以及移植后任何时间的肾脏、胰腺或患者生存率方面均未发现差异。
我们的结果表明，除了肾移植延迟功能恢复率较高外，使用DCD供体器官的SPK移植与使用NDD供体器官的标准移植具有相当的结果。
