Department of Hepatobiliary and Transplant Surgery, Grafton, Auckland, New Zealand.
Department of Hepatopancreaticobiliary and Transplant Surgery, Grafton, Auckland, New Zealand.
Nephrol Dial Transplant. 2019 Oct 1;34(10):1788-1798. doi: 10.1093/ndt/gfy160.
This study compared long-term outcomes of renal transplantation from donors following donation after circulatory death (DCD) with those following donation after brain death (DBD) from one of the largest centres in the UK.
Recipients of renal transplants from deceased donors between 2002 and 2014 were identified from a prospectively maintained database. Outcomes were compared between DCD (468) and DBD (905) donors and between standard criteria donors (SCDs) and extended criteria donors (ECDs).
Graft survival (GS) and patient survival (PS) from DCD and DBD donors were comparable up to 10 years (GS: 61 versus 55%, P = 0.780; PS: 78 versus 71%, P = 0.285, respectively). Graft function was comparable after 3 months. GS and function were worse in the ECD groups, with no difference between EC-DBD and EC-DCD. PS in the ECD groups was worse than the SCD groups and PS in the EC-DCD group was worse than in the EC-DBD group. DCD donors were an independent risk factor for delayed graft function. Post-operative complications and EC-DCD donation were independent risk factors for reduced GS and PS.
This study supports the use of DCD renal grafts with comparable long-term survival and function to DBD grafts. The use of EC-DCD grafts is justified in selected recipients and provides acceptable function and survival advantages over dialysis.
本研究比较了来自英国最大中心之一的脑死亡供体（DBD）和心脏死亡后供体（DCD）的长期肾移植结果。
从 2002 年至 2014 年期间接受过已故供体肾移植的患者，从一个前瞻性维护的数据库中确定。比较了 DCD（468 例）和 DBD（905 例）供体之间以及标准标准供体（SCD）和扩展标准供体（ECD）之间的结果。
DCD 和 DBD 供体的移植物存活率（GS）和患者存活率（PS）在 10 年内相当（GS：61%与 55%，P=0.780；PS：78%与 71%，P=0.285）。3 个月后移植物功能相当。ECD 组的 GS 和功能较差，EC-DBD 和 EC-DCD 之间无差异。ECD 组的 PS 比 SCD 组差，EC-DCD 组的 PS 比 EC-DBD 组差。DCD 供体是延迟移植物功能的独立危险因素。术后并发症和 EC-DCD 供体是降低 GS 和 PS 的独立危险因素。
本研究支持使用 DCD 肾移植物，其长期存活率和功能与 DBD 移植物相当。在选定的受者中使用 EC-DCD 移植物是合理的，与透析相比，它提供了可接受的功能和生存优势。
