Bauer Jana, Grzella Sascha, Bialobrzecka Malwina, Berger Lea, Westhoff Timm H, Viebahn Richard, Schenker Peter
Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany.
Medical Department I, University Hospital Marien Hospital Herne, Ruhr University, Herne, Germany.
Ann Transplant. 2018 Dec 7;23:836-844. doi: 10.12659/AOT.912660.
BACKGROUND The acceptance of organs from deceased donors with acute kidney injury (AKI) varies considerably, with uncertain outcomes. The current organ shortage has led to increased use of marginal donor organs. MATERIAL AND METHODS This retrospective, single-center study included 642 patients who underwent kidney allograft transplantation between 2005 and 2016. The recipients were categorized into 3 groups: AKI-1 (n=214), comprising donors with a peak serum creatinine (SCr) level of 1.1-2.0 mg/dl; AKI-2 (n=89), comprising donors with a peak SCr level >2 mg/dl; and non-AKI (n=339), comprising donors with normal kidney function (SCr <1.1 mg/dl). RESULTS The cumulative survival rates for patients and grafts did not significantly differ among the AKI-1, AKI-2, and non-AKI groups at the 1-year (91.6%/79.4%, 92.1%/83.1%, 95.3%/88.5%, respectively) and 5-year assessments (79.4%/67.8%, 86.8%/71.7%, 80.5%/71.1%, respectively). These findings were corroborated by mean SCr values and estimated glomerular filtration rates at the 1-year (2.08±1.7/51.16±23.45, 2.01±1.52/56.46±23.63, 1.81±1.13/55.44±23.26 mg/dl, respectively) and 5-year assessments (1.91±1.28/51.06±24.65, 1.74±0.66/57.44±31.21, 1.7±0.88/58.56±26.04 mg/dl, respectively). The incidence of delayed graft function in each group was 29.9%, 44.9%, and 28.6%, respectively. CONCLUSIONS Kidney transplantation from donors with AKI, although associated with a higher rate of delayed graft function, results in good long-term transplant survival and reliable kidney functionality after 5 years. The inclusion of donors with AKI may widely extend the pool of available organs; however, careful donor selection is necessary.
接受急性肾损伤（AKI）死者捐赠者的器官情况差异很大，其结果尚不确定。当前器官短缺导致边缘供体器官的使用增加。
这项回顾性单中心研究纳入了2005年至2016年间接受同种异体肾移植的642例患者。接受者被分为3组：AKI-1组（n = 214），包括血清肌酐（SCr）峰值水平为1.1 - 2.0mg/dl的捐赠者；AKI-2组（n = 89），包括SCr峰值水平>2mg/dl的捐赠者；非AKI组（n = 339），包括肾功能正常（SCr<1.1mg/dl）的捐赠者。
在1年（分别为91.6%/79.4%、92.1%/83.1%、95.3%/88.5%）和5年评估（分别为79.4%/67.8%、86.8%/71.7%、80.5%/71.1%）时，AKI-1组、AKI-2组和非AKI组患者及移植物的累积生存率无显著差异。这些结果在1年（分别为2.08±1.7/51.16±23.45、2.01±1.52/56.46±23.63、1.81±1.13/55.44±23.26mg/dl）和5年评估（分别为1.91±1.28/51.06±24.65、1.74±0.66/57.44±31.21、1.7±0.88/58.56±26.04mg/dl）时的平均SCr值和估计肾小球滤过率中得到证实。每组移植肾功能延迟恢复的发生率分别为29.9%、44.9%和28.6%。
来自AKI捐赠者的肾移植，虽然与移植肾功能延迟恢复率较高相关，但5年后移植长期生存率良好且肾功能可靠。纳入AKI捐赠者可能会广泛扩大可用器官库；然而，需要谨慎选择捐赠者。
