心脏死亡后肾移植与脑死亡后肾移植的比较：一项随访1年后的单中心回顾性研究。

Comparison Between Kidney Transplantation After Circulatory Death and After Brain Death: A Monocentric Retrospective Study After 1 Year of Follow-up.

作者信息

Mori Giacomo, Solazzo Andrea, Tonelli Laura, Facchini Francesca, Fontana Francesco, Alfano Gaetano, Baroni Stefano, Cappelli Gianni

机构信息

Surgical, Medical, and Dental Department of Morphological Sciences, Section of Nephrology, University Hospital of Modena, Modena, Italy.

出版信息

Transplant Proc. 2020 Jun;52(5):1536-1538. doi: 10.1016/j.transproceed.2020.02.043. Epub 2020 Apr 4.

DOI:10.1016/j.transproceed.2020.02.043

PMID:32252998

Abstract

BACKGROUND

Donation after circulatory death (DCD) is a solid resource to widen the kidney donor pool. Italian activity has grown in the last years with encouraging results. Our center has been active in DCD kidney transplantation (KTX) since November 2017, providing 22.5% of Italian DCD donations in 2018. We present a single-center retrospective analysis after a 1-year follow-up comparing DCD and donation after brain death (DBD) KTX outcomes.

METHODS

DCD (controlled only) and DBD KTX performed in our center from November 2017 to December 2018 were considered. All DCDs underwent in situ normothermic perfusion with extracorporeal membrane oxygenation, ex situ hypothermic oxygenated perfusion, and renal biopsy prior to allocation. We considered features of donors and recipients, immunosuppressive regimen, delayed graft function (DGF), primary nonfunction (PNF), graft and patient survival (Kaplan-Meier), creatinine, and estimated glomerular filtration rate at 1 year. Mean comparison with a Student t test and with χ test for frequencies were elaborated.

RESULTS

Twenty-eight DBD, 18 double (64.3%) and 10 single (35.7%), were performed; 7 DCD, 3 double (42.8%) and 4 single (57.2%), were performed. By comparing single and double KTX, no statistically significant difference was found. We recorded 7 DGFs (25%) in DBD and 1 (14.3%) in the DCD group (P > .99) and no PNF. No graft was lost during the first year. One-year estimated glomerular filtration rate (Chronic Kidney Disease Epidemiology Collaboration) was, respectively, 62.7 ± 25.3 and 54.71 ± 14.66 mL/min (P = .25). DBD patient survival rate was 92.8%, DCD was 100%, and Kaplan-Meier was not statistically significant (P = .72).

CONCLUSIONS

Controlled DCD is a valid resource for KTX, with similar outcomes to DBD. A multidisciplinary donor evaluation, combining clinical, perfusion, and histologic data in the allocation process, allows excellent results.

摘要

背景

心脏死亡后器官捐献（DCD）是扩大肾供体库的可靠资源。近年来，意大利在这方面的活动有所增加，取得了令人鼓舞的成果。自2017年11月以来，我们中心一直积极开展DCD肾移植（KTX）工作，2018年提供了意大利22.5%的DCD捐献。我们进行了一项单中心回顾性分析，对DCD和脑死亡后器官捐献（DBD）的KTX结果进行了1年的随访比较。

方法

纳入2017年11月至2018年12月在我们中心进行的DCD（仅受控型）和DBD KTX病例。所有DCD在分配前均接受了原位常温体外膜肺氧合灌注、异位低温氧合灌注和肾活检。我们考虑了供体和受体的特征、免疫抑制方案、移植肾功能延迟恢复（DGF）、原发性无功能（PNF）、移植肾和患者生存率（Kaplan-Meier法）、肌酐以及1年时的估计肾小球滤过率。采用Student t检验进行均值比较，采用χ检验进行频率比较。

结果

共进行了28例DBD肾移植，其中18例为双肾移植（64.3%），10例为单肾移植（35.7%）；7例DCD肾移植，其中3例为双肾移植（42.8%），4例为单肾移植（57.2%）。比较单肾和双肾KTX，未发现统计学显著差异。我们记录到DBD组有7例DGF（25%），DCD组有1例（14.3%）（P>.99），且无PNF。第一年无移植肾丢失。1年时的估计肾小球滤过率（慢性肾脏病流行病学协作组公式）分别为62.7±25.3和54.71±14.66 mL/min（P=.25）。DBD患者生存率为92.8%，DCD患者生存率为100%，Kaplan-Meier分析无统计学显著差异（P=.72）。