Sun Qipeng, Zhou Honglan, Cao Ronghua, Lin Minzhuan, Hua Xuefeng, Hong Liangqing, Huang Zhengyu, Na Ning, Cai Ruiming, Wang Gang, Meng Fanhang, Sun Qiquan
Department of Renal Transplantation, The Third Affiliated Hospital, Sun Yat-sen University, Kaichuang Road 2693, Huangpu District, Guangzhou, 510530, People's Republic of China.
Department of Urology, The First Affiliated Hospital, Jilin University, Xinmin Road 71, Changchun, 130000, People's Republic of China.
BMC Nephrol. 2018 Jul 4;19(1):164. doi: 10.1186/s12882-018-0972-8.
Organ donation after brain death (DBD) is the standard strategy for organ transplantation; however, the concept of brain death is not universally accepted due to cultural beliefs and barriers amongst billions of people worldwide. Hence, a novel donation pattern has been established in China which outlines the concept of donation after brain death followed by circulatory death (DBCD). Differently from any current donation classification, this new concept is formulated based on combination of recognizing brain death and circulatory death. Should approval be gained for this definition and approach, DBCD will pave a novel donation option for billions of people who cannot accept DBD due to their cultural beliefs.
A multi-center, cohort study was conducted from February 2012 to December 2015. 523 kidney transplant recipients from four kidney transplant institutions were enrolled into the study, of which, 383 received kidneys from DBCD, and 140 from DBD. Graft and recipient survivals following transplantation were retrospectively analyzed. Postoperative complications including delayed graft function,, and acute rejection, were also analyzed for both groups.
DBCD could achieve comparable graft and recipient survivals in comparison with DBD (Log-rank P = 0.32 and 0.86,respectively). One-year graft and recipient survivals were equal between DBCD and DBD groups (97.4% versus 97.9%, P = 0.10;98.4% versus 98.6%, P = 1.0, respectively). Furthermore, DBCD did not increase incidences of postoperative complications compared with DBD, including delayed graft function (19.3% versus 22.1%, P = 0.46) and acute rejection (9.1% versus 8.6%, P = 1.0). Additionally, antithymocyte globulin as induction therapy and shorter warm ischemia time decreased incidence of delayed graft function in DBCD group (16.8% on antithymocyte globulin versus 27.2% on basiliximab, P = 0.03; 16.7% on ≤18 min versus 26.7% on > 18 min group, P = 0.03).
Kidney donation through DBCD achieves equally successful outcomes as DBD, and could provide a feasible path to graft availability for billions of people who face barriers to organ donation from DBD.
脑死亡后器官捐赠（DBD）是器官移植的标准策略；然而，由于全球数十亿人的文化信仰和障碍，脑死亡的概念并未得到普遍接受。因此，中国建立了一种新的捐赠模式，概述了脑死亡后循环死亡（DBCD）的捐赠概念。与目前任何捐赠分类不同，这一新概念是基于对脑死亡和循环死亡的认识相结合而制定的。如果这一定义及方法获得批准，DBCD将为数十亿因文化信仰而无法接受DBD的人提供一种新的捐赠选择。
2012年2月至2015年12月进行了一项多中心队列研究。来自四个肾脏移植机构的523例肾移植受者纳入研究，其中383例接受了来自DBCD的肾脏，140例接受了来自DBD的肾脏。对移植后的移植物和受者存活率进行回顾性分析。还对两组的术后并发症，包括移植肾功能延迟恢复和急性排斥反应进行了分析。
与DBD相比，DBCD可实现相当的移植物和受者存活率（对数秩检验P分别为0.32和0.86）。DBCD组和DBD组的1年移植物和受者存活率相当（分别为97.4%对97.9%，P = 0.10；98.4%对98.6%，P = 1.0）。此外，与DBD相比，DBCD并未增加术后并发症的发生率，包括移植肾功能延迟恢复（19.3%对22.1%，P = 0.46）和急性排斥反应（9.1%对8.6%，P = 1.0）。此外，抗胸腺细胞球蛋白作为诱导治疗以及较短的热缺血时间降低了DBCD组移植肾功能延迟恢复的发生率（抗胸腺细胞球蛋白组为16.8%，巴利昔单抗组为27.2%，P = 0.03；热缺血时间≤18分钟组为16.7%，>18分钟组为26.7%，P = 0.03）。
通过DBCD进行肾脏捐赠可取得与DBD同样成功的结果，并可为数十亿面临DBD器官捐赠障碍的人提供一条可行的获取移植物的途径。
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