Portolés José M, Pérez-Sáez María José, López-Sánchez Paula, Lafuente-Covarrubias Omar, Juega Javier, Hernández Domingo, Espí Jordi, Navarro María Dolores, Mazuecos María Auxiliadora, Rodríguez-Ferrero María Luisa, Maruri-Kareaga Naroa, Moreso Francesc, Melilli Edoardo, de Souza Erika, Ruiz Juan Carlos, Llamas Francisco, Gutiérrez-Dalmau Alex, Guirado Luis, Martín-Moreno Paloma, Pérez Flores Isabel, Fernández-García Antón, Jiménez Carlos, Gavela Eva, Ramos Ana, Pascual Julio
Hospital Universitario Puerta de Hierro, Madrid, España.
Hospital del Mar, Barcelona, España.
Nefrologia (Engl Ed). 2019 Mar-Apr;39(2):151-159. doi: 10.1016/j.nefro.2018.07.013. Epub 2018 Nov 27.
Many European countries have transplant programmes with controlled donors after cardiac death (cDCD). Twenty-two centres are part of GEODAS group. We analysed clinical results from a nephrological perspective.
Observational, retrospective and multicentre study with systematic inclusion of all kidney transplant recipients from cDCD, following local protocols regarding extraction and immunosuppression.
A total of 335 cDCD donors (mean age 57.2 years) whose deaths were mainly due to cardiovascular events were included. Finally, 566 recipients (mean age 56.5 years; 91.9% first kidney transplant) were analysed with a median of follow-up of 1.9 years. Induction therapy was almost universal (thymoglobulin 67.4%; simulect 32.8%) with maintenance with prednisone-MMF-tacrolimus (91.3%) or combinations with mTOR (6.5%). Mean cold ischaemia time (CIT) was 12.3h. Approximately 3.4% (n=19) of recipients experienced primary non-function, essentially associated with CIT (only CIT ≥ 14 h was associated with primary non-function). Delayed graft function (DGF) was 48.8%. DGF risk factors were CIT ≥ 14 h OR 1.6, previous haemodialysis (vs. peritoneal dialysis) OR 2.1 and donor age OR 1.01 (per year). Twenty-one patients (3.7%) died with a functioning graft, with a recipient and death-censored graft survival at 2-years of 95% and 95.1%, respectively. The estimated glomerular filtration rate at one year of follow-up was 60.9 ml/min.
CIT is a modifiable factor for improving the incidence of primary non-function in kidney transplant arising from cDCD. cDCD kidney transplant recipients have higher delayed graft function rate, but the same patient and graft survival compared to brain-dead donation in historical references. These results are convincing enough to continue fostering this type of donation.
许多欧洲国家都开展了心脏死亡后器官捐献（cDCD）的移植项目。22个中心是GEODAS组织的成员。我们从肾脏病学角度分析了临床结果。
采用观察性、回顾性多中心研究，按照当地关于器官获取和免疫抑制的方案，系统纳入所有cDCD肾移植受者。
共纳入335例cDCD供者（平均年龄57.2岁），其死亡主要归因于心血管事件。最终，对566例受者（平均年龄56.5岁；91.9%为首次肾移植）进行了分析，中位随访时间为1.9年。诱导治疗几乎普及（抗胸腺细胞球蛋白占67.4%；舒莱占32.8%），维持治疗采用泼尼松-霉酚酸酯-他克莫司方案（91.3%）或与雷帕霉素靶蛋白联合方案（6.5%）。平均冷缺血时间（CIT）为12.3小时。约3.4%（n = 19）的受者发生原发性无功能，主要与CIT相关（仅CIT≥14小时与原发性无功能相关）。移植肾功能延迟恢复（DGF）发生率为48.8%。DGF的危险因素包括CIT≥14小时（比值比[OR]为1.6）、既往血液透析（对比腹膜透析，OR为2.1）以及供者年龄（每年OR为1.01）。21例患者（3.7%）在移植肾功能良好时死亡，2年时受者和死亡截尾的移植肾存活率分别为95%和95.1%。随访1年时的估计肾小球滤过率为60.9 ml/min。
CIT是一个可调节的因素，可改善cDCD肾移植中原发性无功能的发生率。cDCD肾移植受者的移植肾功能延迟恢复率较高，但与历史对照中脑死亡供者肾移植相比，受者和移植肾存活率相同。这些结果足以令人信服地继续推动此类捐献。
