Mistry Umesh, Dargan Paul I, Wood David M
General Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Med Toxicol. 2018 Dec;14(4):278-282. doi: 10.1007/s13181-018-0673-5. Epub 2018 Jul 9.
The gap between the number of patients on transplant waiting lists and patients receiving transplants is growing. Use of organs from donors who have died following pesticide exposure remains controversial. This study reviews the literature related to transplantation from this group.
A literature search was undertaken on PubMed using the following keywords: 'insecticide', 'pesticide', 'rodenticide', 'organophosphate', 'carbamate', 'paraquat', 'poisoning', 'toxicity', 'overdose', 'intoxication', 'ingestion', 'organ donation or procurement', 'transplant', 'allograft transplant', and 'expanded criteria organ donation'; 21 specific pesticides/insecticides were also added to the search; the indexes for EAPCCT/NACCT meeting abstracts 2008-2017 were also searched. Identified publications were reviewed and if described human donation/transplantation of ≥ 1 solid organ(s), the following was extracted: (i) compound(s) ingested; (ii) donor demographics; (iii) organ(s) transplanted; and (iv) graft function at follow-up.
Ten papers were identified describing 20 fatalities (1999-2017) related to the following pesticide exposures: organophosphate, 8 cases; aldicarb, 4; paraquat, 3; parathion, 1; malathion, 1; carbofuran/carbamate, 1; carbamate, 1; and brodifacoum, 1 and no further cases were identified from EAPCCT/NACCT abstracts. Donors were aged 12-50 (25.9 ± 11.9) years. Forty-four organs were transplanted: 28 kidneys, 7 livers, 6 corneas, and 3 hearts. Forty recipients had outcome reported: 3 (7.5%) patients died, 3 (7.5%) had graft failure/dysfunction and 34 (85.0%) had good graft function. Overall survival with good function was 96%, 71%, 83%, and 67% for kidneys, livers, corneas and hearts respectively.
Review of the published literature suggests that solid organ donation following exposure to a pesticide is associated with good short-to-medium-term graft organ function following transplantation, particularly for transplanted kidneys and corneas.
移植等待名单上的患者数量与接受移植的患者数量之间的差距正在扩大。使用农药暴露后死亡的供体器官仍然存在争议。本研究回顾了与该组供体移植相关的文献。
在PubMed上进行文献检索，使用以下关键词：“杀虫剂”、“农药”、“杀鼠剂”、“有机磷”、“氨基甲酸酯”、“百草枯”、“中毒”、“毒性”、“过量”、“中毒”、“摄入”、“器官捐赠或获取”、“移植”、“同种异体移植”和“扩大标准器官捐赠”；还在搜索中添加了21种特定的农药/杀虫剂；还搜索了2008 - 2017年EAPCCT/NACCT会议摘要索引。对识别出的出版物进行了审查，如果描述了≥1个实体器官的人类捐赠/移植，则提取以下信息：(i)摄入的化合物；(ii)供体人口统计学信息；(iii)移植的器官；(iv)随访时的移植物功能。
共识别出10篇论文，描述了20例与以下农药暴露相关的死亡病例（1999 - 2017年）：有机磷，8例；涕灭威，4例；百草枯，3例；对硫磷，1例；马拉硫磷，1例；克百威/氨基甲酸酯，1例；氨基甲酸酯，1例；溴敌隆，1例，EAPCCT/NACCT摘要中未发现更多病例。供体年龄为12 - 50（25.9±11.9）岁。共移植了44个器官：28个肾脏、7个肝脏、6个角膜和3个心脏。40名受者的结局有报告：3例（7.5%）患者死亡，3例（7.5%）发生移植物衰竭/功能障碍，34例（85.0%）移植物功能良好。肾脏、肝脏、角膜和心脏功能良好的总体生存率分别为96%、71%、83%和67%。
对已发表文献的回顾表明，农药暴露后的实体器官捐赠与移植后良好的短期至中期移植物器官功能相关，尤其是对于移植的肾脏和角膜。
