Summers Dominic M, Pettigrew Gavin J
Department of Surgery, University of Cambridge, Cambridge, UK.
Curr Opin Organ Transplant. 2020 Apr;25(2):144-150. doi: 10.1097/MOT.0000000000000742.
The identification and utilization of kidneys from uncontrolled donation after circulatory death (uDCD) donors for transplantation may increase transplantation rates markedly. This article summarizes the latest international results from successful uDCD kidney transplant programmes and considers how such programmes may impact on the transplant waiting list.
The results of more than 1000 uDCD donor kidney transplants have been reported since 2007 from France and Spain. Estimates from France, Spain and Sweden suggest that effective utilization of the potential uDCD donor pool might increase donation rates by 25%. The main concern relating to uDCD kidney transplantation is the high incidence of primary nonfunction with the incidence of primary nonfunction reported as 7-8% even with careful donor selection and the use of normothermic regional perfusion at the time of organ recovery. Notwithstanding, reported 1- year graft survival figures are equivalent to those from expanded criteria donors (ECD) and 10-year graft survival of between 72 and 82% was reported in the two single-centre series with longest reported follow-up period.
Uncontrolled DCD kidney transplantation has been successfully implemented in several regions in France and Spain. Wider implementation of uDCD programmes would increase substantially the number of kidneys for transplantation, while maintaining acceptable transplant outcomes.
识别并利用来自循环死亡后非受控捐赠（uDCD）供体的肾脏进行移植，可能会显著提高移植率。本文总结了成功的uDCD肾脏移植项目的最新国际成果，并探讨此类项目可能如何影响移植等待名单。
自2007年以来，法国和西班牙已报告了1000多例uDCD供体肾脏移植的结果。法国、西班牙和瑞典的估计表明，有效利用潜在的uDCD供体库可能会使捐赠率提高25%。与uDCD肾脏移植相关的主要担忧是原发性无功能的高发生率，即使在仔细选择供体并在器官获取时使用常温区域灌注的情况下，原发性无功能的发生率仍报告为7-8%。尽管如此，报告的1年移植物存活率数据与扩展标准供体（ECD）的相当，在两个随访期最长的单中心系列中，报告的10年移植物存活率在72%至82%之间。
法国和西班牙的几个地区已成功实施了非受控DCD肾脏移植。更广泛地实施uDCD项目将大幅增加可用于移植的肾脏数量，同时保持可接受的移植结果。
