Department of Medicine, Centre Hospitalier Universitaire de Montréal, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Am J Transplant. 2019 Jan;19(1):277-284. doi: 10.1111/ajt.15127. Epub 2018 Oct 29.
Meeting donor management goals (DMGs) has been reported to decrease the incidence of delayed graft function (DGF) after kidney transplant, but whether this relationship is independent of cold machine perfusion is unclear. We aimed to determine whether meeting DMGs is associated with a reduced incidence of DGF, independent of the use of machine perfusion. We collected data on consecutive brain-dead donors and their KT recipients (KTRs) between June 2013 and December 2016 in 5 adult transplant centers. We evaluated whether DMGs were met at donor neurologic death (DND) and later time points. We defined a priori meeting optimal DMG as achieving ≥7 DMGs. Generalized estimating equations were used to predict DGF. Among 122 donors, 34% were extended-criteria donors (ECDs). The number of DMGs met increased over time (5.6 ± 1.4 at DND and 6.1 ± 1.3 at organ procurement [P < .001]). DGF occurred in 23% of 214 KTRs, and 55% received organs placed on machine perfusion. In multivariate analysis, ECD (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.13-4.45), use of machine perfusion (OR 0.45, 95% CI 0.22-0.94), and optimal DMG at DND (OR 0.39, 95% CI 0.16-0.99) were associated with DGF. Early achievement of DMGs was associated with a reduced risk of the development of DGF, independent of the use of machine perfusion.
达到供者管理目标（DMG）已被报道可降低肾移植后延迟肾功能恢复（DGF）的发生率，但这种关系是否独立于机器冷灌注尚不清楚。我们旨在确定达到 DMG 是否与 DGF 发生率降低相关，而不考虑使用机器灌注。我们收集了 2013 年 6 月至 2016 年 12 月期间 5 个成人移植中心连续脑死亡供者及其肾移植受者（KTR）的数据。我们评估了在供者神经死亡（DND）和随后的时间点是否达到 DMG。我们将达到≥7 个 DMG 定义为预先设定的达到最优 DMG。采用广义估计方程预测 DGF。在 122 名供者中，34%为扩展标准供者（ECD）。达到 DMG 的数量随时间增加（DND 时为 5.6±1.4，器官获取时为 6.1±1.3，P<.001）。214 名 KTR 中有 23%发生 DGF，55%接受了放置在机器灌注上的器官。多变量分析显示，ECD（比值比[OR] 2.24，95%置信区间[CI] 1.13-4.45）、使用机器灌注（OR 0.45，95%CI 0.22-0.94）和 DND 时达到最优 DMG（OR 0.39，95%CI 0.16-0.99）与 DGF 相关。早期达到 DMG 与 DGF 发生风险降低相关，而与使用机器灌注无关。
