Division of Transplant Surgery, Department of Surgery, Northwell Health, Manhasset, NY.
Transplantation. 2021 Apr 1;105(4):886-890. doi: 10.1097/TP.0000000000003317.
Deceased donor kidneys with acute kidney injury (AKI) and donation after circulatory death (DCD) kidneys are viable sources of organs. The outcomes of renal transplantation from DCD donors with AKI are not known.
A retrospective review of deceased donor renal transplants performed from 2006 to 2016 was conducted using the United Network for Organ Sharing dataset. Donors were stratified by DCD or brain dead status and by AKI stage. Recipients were followed until graft failure or the end of study. Cox regression was used to adjust for donor, recipient, and transplant covariates known to affect the incidence of delayed graft function and graft survival.
A total of 135 644 patients were included in the study. The odds of delayed graft function among DCD recipients were significantly higher across all donor AKI stages. The unadjusted risk of overall and death-censored graft failure were similar between the 2 groups. After adjusting for covariates, there was a significant increase in the risk of overall graft failure in recipients of DCD allografts from donors with stage 2 AKI. There was also a higher risk of death-censored graft failure among stage 1 and 2 AKI DCD recipients.
DCD renal allografts from donors experiencing stage 1 and 2 AKI have a higher adjusted risk of death-censored graft failure than AKI stage-matched donation after brain death renal allografts. Their use, however, is still associated with improved outcomes compared with waitlist mortality.
患有急性肾损伤（AKI）的已故供体肾脏和心脏死亡后（DCD）的肾脏是可行的器官来源。患有 AKI 的 DCD 供体的肾脏移植结果尚不清楚。
使用美国器官共享网络数据集对 2006 年至 2016 年期间进行的已故供体肾移植进行回顾性研究。根据 DCD 或脑死亡状态以及 AKI 分期对供体进行分层。受者随访至移植物失功或研究结束。Cox 回归用于调整已知影响延迟移植物功能和移植物存活发生率的供体、受者和移植协变量。
共有 135644 例患者纳入本研究。在所有供体 AKI 分期中，DCD 受者发生延迟移植物功能的可能性明显更高。2 组之间的总体和死亡相关移植物失败风险无差异。在调整协变量后，2 期 AKI 的 DCD 供体来源的同种异体移植物受者的总体移植物失败风险显著增加。1 期和 2 期 AKI 的 DCD 受者的死亡相关移植物失败风险也更高。
与 AKI 匹配的脑死亡后供体来源的同种异体移植物相比，患有 1 期和 2 期 AKI 的 DCD 供体的肾脏同种异体移植物在调整后的死亡相关移植物失败风险更高。然而，与等待名单死亡率相比，它们的使用仍然与改善的结局相关。
