Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France.
CHU Saint Louis (APHP), Urologie, Paris, France.
Transplantation. 2020 Jan;104(1):130-136. doi: 10.1097/TP.0000000000002753.
The French uncontrolled donors after circulatory death (DCD) protocol restricts donor age to <55 years, no-flow time to <30 minutes, and functional warm ischemia time to <150 minutes. In situ kidney perfusion can be performed at either 4°C (in situ cooling [ISC]) or 33-36°C (normothermic regional perfusion [NRP]). Hypothermic machine perfusion is systematically used. Only nonimmunized first transplant recipients were eligible. To improve the management of uncontrolled DCD, we tried to identify factors predictive of outcome.
We identified all kidney transplants from uncontrolled DCD between 2007 and 2014 from the French Transplant Registry. Risk factors for primary nonfunction (PNF; n = 37) and poor renal function (estimated glomerular filtration rate < 30 mL/min or graft loss at 1 y, n = 66) were analyzed by using a multivariate logistic model.
This study analyzed 499 kidney transplantations, 50% of which were performed with NRP. Mean functional warm ischemia time was 135 minutes. Mean cold ischemia time was 14 hours. The principal PNF risk factor was young donor age (odds ratio [OR] = 0.95; P = 0.002). A sensitivity analysis showed a higher risk of PNF with ISC than with NRP (OR = 4.5; P = 0.015). Risk factors for poor renal function were donor body mass index (OR = 1.2; P < 0.001) and ISC versus NRP. Univariate analysis of uncontrolled DCD-specific risk factors showed no-flow time, functional warm time, and cold ischemia time did not affect the risk of PNF or poor renal function.
Uncontrolled DCD kidneys are an additional source of valuable transplants. NRP appears to decrease graft failure by restoring oxygenated blood as the first step of preconditioning.
法国的循环死亡后未控制供体（DCD）方案将供体年龄限制在<55 岁，无血流时间<30 分钟，功能热缺血时间<150 分钟。可以在 4°C（原位冷却[ISC]）或 33-36°C（常温区域灌注[NRP]）下进行肾脏原位灌注。低温机器灌注被系统使用。只有未免疫的首次移植受者符合条件。为了改善对未控制 DCD 的管理，我们试图确定预测结果的因素。
我们从法国移植登记处确定了 2007 年至 2014 年期间所有来自未控制 DCD 的肾移植。使用多变量逻辑模型分析了原发性无功能（PNF；n=37）和肾功能不良（估计肾小球滤过率<30ml/min 或 1 年时移植物丢失，n=66）的主要危险因素。
这项研究分析了 499 例肾移植，其中 50%的肾移植采用 NRP 进行。平均功能热缺血时间为 135 分钟。平均冷缺血时间为 14 小时。主要的 PNF 危险因素是年轻的供体年龄（比值比[OR] = 0.95；P = 0.002）。敏感性分析显示，ISC 比 NRP 发生 PNF 的风险更高（OR = 4.5；P = 0.015）。肾功能不良的危险因素是供体体重指数（OR = 1.2；P<0.001）和 ISC 与 NRP。对未控制 DCD 特异性危险因素的单因素分析显示，无血流时间、功能热时间和冷缺血时间并不影响 PNF 或肾功能不良的风险。
未控制的 DCD 肾脏是有价值的移植的另一个来源。NRP 通过恢复富含氧的血液作为预处理的第一步，似乎降低了移植物失功的风险。
