Wake Forest School of Medicine, Winston-Salem, NC.
Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC.
J Am Coll Surg. 2021 Apr;232(4):493-502. doi: 10.1016/j.jamcollsurg.2020.12.005. Epub 2020 Dec 19.
Decreasing kidney discards continues to be of paramount importance for improving organ transplant access, but transplantation of nonideal deceased donor kidneys may have higher inherent risks of early graft loss (EGL). Patients with EGL (defined as graft failure within 90 days after transplant) are allowed reinstatement of waiting time according to United Network for Organ Sharing (UNOS) policy. The purpose of this study was to examine outcomes for patients experiencing EGL.
We performed a single center retrospective review of adult deceased donor kidney transplant (DDKT)-alone recipients from 2001 to 2018, comparing those with EGL (including primary nonfunction [PNF]) to those without.
EGL occurred in 103 (5.5%) of 1,868 patients, including 57 (55%) PNF, 25 (24%) deaths, 16 (16%) thrombosis, 3 (3%) rejection, and 2 (2%) disease recurrence. Kidney Donor Profile Index (KDPI) > 85% and donation after circulatory death (DCD) DDKTs did not increase risk of either EGL or PNF unless combined with prolonged cold ischemic time (CIT). For KDPI >85% with CIT >24 hours, the risk of EGL or PNF was tripled (EGL odds ratio [OR] 2.9, 95% CI 1.6-5.2; PNF OR3.6, 95% CI1.7-7.7). For DCD with CIT > 24 hours, increased risks were likewise seen for EGL (OR 2.4, 95% CI 1.3-4.3), and PNF (OR 3.2, 95% CI 1.5-7). One-year and 5-year patient survival rates were 60% and 50% after EGL, 80% and 73% after PNF, and 99% and 87% for controls, respectively. Only 24% of either EGL or PNF patients underwent retransplantation.
EGL and PNF were associated with low retransplantation rates and inferior patient survival. Prolonged CIT compounds risks associated with KDPI > 85% and DCD donor kidneys. Therefore, policies promoting rapid allocation and increased local use of these kidneys should be considered.
为了提高器官移植的可及性，减少肾脏废弃仍然至关重要，但移植非理想的已故供体肾脏可能会增加早期移植物丢失（EGL）的固有风险。根据美国器官共享网络（UNOS）的政策，EGL 患者（定义为移植后 90 天内发生移植物失败）允许恢复等待时间。本研究的目的是检查经历 EGL 的患者的结局。
我们对 2001 年至 2018 年期间接受成人已故供体肾移植（DDKT）的患者进行了单中心回顾性研究，比较了 EGL（包括原发性无功能[PNF]）患者与无 EGL 患者。
在 1868 例患者中，有 103 例（5.5%）发生 EGL，包括 57 例（55%）PNF、25 例（24%）死亡、16 例（16%）血栓形成、3 例（3%）排斥反应和 2 例（2%）疾病复发。KDPI>85%和心脏死亡后捐献（DCD）DDKT 并未增加 EGL 或 PNF 的风险，除非与延长冷缺血时间（CIT）相结合。对于 KDPI>85%且 CIT>24 小时的患者，EGL 或 PNF 的风险增加了两倍（EGL 比值比[OR]2.9，95%CI1.6-5.2；PNF OR3.6，95%CI1.7-7.7）。对于 CIT>24 小时的 DCD，EGL（OR2.4，95%CI1.3-4.3）和 PNF（OR3.2，95%CI1.5-7）的风险也相应增加。EGL 后 1 年和 5 年患者生存率分别为 60%和 50%，PNF 后分别为 80%和 73%，对照组分别为 99%和 87%。只有 24%的 EGL 或 PNF 患者接受了再次移植。
EGL 和 PNF 与低再移植率和较差的患者生存率相关。延长 CIT 会增加 KDPI>85%和 DCD 供体肾脏相关的风险。因此，应考虑制定促进这些肾脏快速分配和增加当地使用的政策。
