Urology Department, Ramón y Cajal University Hospital, Surgical Urology and Transplantation Research Group, IRYCIS, Alcalá University, Madrid, Spain.
Urology Department, Ramón y Cajal University Hospital, Surgical Urology and Transplantation Research Group, IRYCIS, Alcalá University, Madrid, Spain.
Eur Urol Focus. 2018 Mar;4(2):163-168. doi: 10.1016/j.euf.2018.05.011.
Hypothermic machine perfusion (HMP) of deceased donor kidneys is associated with a better outcome than static cold storage, predominantly in marginal donors. Nevertheless, there is little evidence supporting whether graft centre of origin and donor category impact HMP results.
To identify factors impacting HMP in transplantation from marginal donors.
DESIGN, SETTING, AND PARTICIPANTS: Analysis of prospectively collected cohort data of expanded criteria donor (ECD) and donor after circulatory death (DCD) categories II and III was performed. A total of 214 adult recipients of first kidney transplantation with complete data and a minimum of 6-mo follow-up were included.
Delayed graft function (DGF) was defined as the lack of decrease in creatinine level in the first 48h. Graft loss was defined as return to dialysis or creatinine clearance <15ml/min/1.73m. Univariate and multivariate logistic regression analyses for DGF were constructed to identify independent risk factors. Recipient and graft survival (GS) analyses were conducted by Kaplan-Meier, and univariate and multivariate Cox regression analyses.
DGF occurred in 32.8% of imported and 20.5% of local grafts (p=0.059). Only donor category (DCD; odds ratio [OR]: 6.6, p=0.008) and haemodialysis (OR: 3.5, p=0.002) were significantly associated with DGF development. The 1-yr GS rate was 92.5% in the local donor group and 84.3% in the imported donor group (p=0.050). Multivariate analysis by Cox proportional hazards model identified only donor category (hazard ratio [HR] 10.99, p=0.001) and donor age (HR 1.07, p=0.005) as predictive variables for GS. The small sample size of the DCD group diminished the statistical power and did not permit a subgroup analysis to determine the impact of specific DCD category on HMP results.
DCD donor category, but not donor centre of origin, impacted DGF development and GS in the HMP of deceased donor kidneys.
Currently, the number of donors is insufficient to meet the demand for renal grafts. Expanded criteria for donation after brain death and donation after circulatory death (DCD) programmes have been developed as strategies to minimise this problem. Hypothermic machine perfusion has previously demonstrated its usefulness in expanded criteria donation and DCD preservation. DCD type and donor age increase the risk of graft loss.
与静态低温保存相比，死亡供体肾脏的低温机器灌注（HMP）与更好的结果相关，主要是在边缘供体中。然而，几乎没有证据支持供体中心起源和供体类别是否影响 HMP 结果。
确定影响边缘供体中 HMP 的因素。
设计、设置和参与者：对扩展标准供体（ECD）和 II 类和 III 类循环死亡后供体（DCD）类别的前瞻性收集队列数据进行了分析。总共纳入了 214 名接受首次肾移植的成年受者，他们的数据完整，且至少有 6 个月的随访。
定义延迟移植物功能障碍（DGF）为在最初 48 小时内肌酐水平没有下降。移植物丢失定义为返回透析或肌酐清除率<15ml/min/1.73m。构建了用于 DGF 的单变量和多变量逻辑回归分析，以确定独立的危险因素。通过 Kaplan-Meier 进行受者和移植物存活率（GS）分析，并进行单变量和多变量 Cox 回归分析。
进口移植物的 DGF 发生率为 32.8%，本地移植物为 20.5%（p=0.059）。只有供体类别（DCD；比值比[OR]：6.6，p=0.008）和血液透析（OR：3.5，p=0.002）与 DGF 的发展显著相关。本地供体组的 1 年 GS 率为 92.5%，进口供体组为 84.3%（p=0.050）。Cox 比例风险模型的多变量分析仅确定供体类别（危险比[HR] 10.99，p=0.001）和供体年龄（HR 1.07，p=0.005）是 GS 的预测变量。DCD 组的样本量小，降低了统计能力，并且不允许进行亚组分析以确定特定的 DCD 类别对 HMP 结果的影响。
DCD 供体类别，而不是供体中心起源，影响了死亡供体肾脏 HMP 中 DGF 的发展和 GS。
目前，捐赠者的数量不足以满足肾移植物的需求。脑死亡后和循环死亡后（DCD）方案的扩展标准捐赠已被开发为解决此问题的策略。低温机器灌注先前已证明在扩展标准捐赠和 DCD 保存中有用。DCD 类型和供体年龄增加移植物丢失的风险。
