Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Clin Transplant. 2020 Jul;34(7):e13881. doi: 10.1111/ctr.13881. Epub 2020 May 8.
Continued comparison of kidney transplant outcomes between older DCD and donation after brain death (DBD) donors is needed to safely expand the deceased donor pool.
We performed a retrospective cohort study using the UNOS/OPTN transplant registry from donors >50 years old between 1994 and 2016. Donor age was stratified into 4 groups: 50-54, 55-59, 60-64, and >65 years old. Rates of delayed graft function (DGF) and primary non-function (PNF) were compared. Multivariable Cox regression models were constructed to identify factors associated with time to graft failure.
The DCD donors within each age group had fewer comorbidities than the DBD donors. Graft survival for DCD kidneys was equivalent or superior to DBD kidneys in all donor age groups. DGF rates were significantly greater for DCD kidneys in all age groups. PNF rates across all groups were similar. In multivariable analysis, DCD status was not independently associated with time to all-cause graft failure in the 50-54 donor age group (HR = 1.02, 95% CI = 0.93-1.13), 55-59 donor age group (HR = 1.07, 95% CI = 0.96-1.19), or 60-64 donor age group (HR = 1.135, 95% CI = 0.97-1.32).
Kidneys from carefully selected older DCD donors, particularly ages 50-64, are a potential means to safely expand the deceased donor pool.
为了安全地扩大已故供体池，需要继续比较老年 DCD 和脑死亡后供体（DBD）供体的肾移植结果。
我们使用 1994 年至 2016 年间 UNOS/OPTN 移植登记处进行了一项回顾性队列研究。供体年龄分为 4 组：50-54 岁、55-59 岁、60-64 岁和>65 岁。比较延迟移植物功能障碍（DGF）和原发性无功能（PNF）的发生率。构建多变量 Cox 回归模型以确定与移植物衰竭时间相关的因素。
每个年龄组的 DCD 供体的合并症少于 DBD 供体。在所有供体年龄组中，DCD 供体的移植物存活率与 DBD 供体相当或更高。在所有年龄组中，DCD 供体的 DGF 发生率明显更高。所有组的 PNF 发生率相似。在多变量分析中，在 50-54 岁供体年龄组（HR=1.02，95%CI=0.93-1.13）、55-59 岁供体年龄组（HR=1.07，95%CI=0.96-1.19）或 60-64 岁供体年龄组中，DCD 状态与全因移植物衰竭时间无关（HR=1.135，95%CI=0.97-1.32）。
精心挑选的老年 DCD 供体，特别是 50-64 岁的供体，是安全扩大已故供体池的一种潜在方法。
