Alechinsky Louise, Abdessater Maher, Parra Jerôme, Malaquin Géraldine, Huot Olivier, Bastien Olivier, Barrou Benoit, Drouin Sarah J
Department of Urology and Renal Transplantation, APHP - Sorbonne University, Pitié Salpêtrière University Hospital, Paris, France.
Agence de la Biomédecine, Saint Denis la Plaine Cedex, France.
Transpl Int. 2021 Oct;34(10):1845-1852. doi: 10.1111/tri.13844. Epub 2021 Sep 14.
Despite the organ shortage, a significant number of deceased donor kidneys are retrieved but not transplanted (RNTK). This study aims to describe and analyze the main causes of potential grafts discard and to propose adequate solutions. We collected data from the Cristal database of the French Biomedicine Agency about RNTK over one year. Expert opinion was taken from urologists with extensive expertise in renal transplantation. They retrospectively analyzed each record to assess the appropriateness of each graft refusal and subsequent kidney discard. Of 252 kidneys were retrieved but not transplanted in France over one year. The main reasons for discard were vascular abnormalities in 43.7% (n = 110), suspicion of malignant tumor in 18.7% (n = 47), and severe histological lesions on preimplantation biopsy in 12.3% (n = 31). The reason for kidney refusal was undetermined in 4.8% (n = 12). Iatrogenic lesions were responsible for 26.2% (n = 66). Overall, 46.0% (n = 16) and 25.0% (n = 63) of the grafts were, respectively, properly and improperly denied, and the analysis was not possible in 29.0% (n = 73). In total, 36.9% of RNTK could have been transplanted. Reduction of iatrogenic lesions, improvement of microsurgical repair skills, and proper histological examination are necessary to reduce the number of RNTK. A prospective study applying the proposed principles is undoubtedly essential to complete this work.
尽管存在器官短缺问题，但仍有相当数量的已故捐赠者肾脏被获取但未进行移植（RNTK）。本研究旨在描述和分析潜在移植物被丢弃的主要原因，并提出适当的解决方案。我们从法国生物医学机构的Cristal数据库中收集了关于一年内RNTK的数据。专家意见来自在肾移植方面具有丰富专业知识的泌尿科医生。他们对每条记录进行回顾性分析，以评估每次拒绝移植及随后肾脏丢弃的合理性。在法国，一年内有252个肾脏被获取但未进行移植。丢弃的主要原因是血管异常，占43.7%（n = 110），怀疑有恶性肿瘤，占18.7%（n = 47），以及植入前活检发现严重组织学病变，占12.3%（n = 31）。肾脏被拒绝的原因在4.8%（n = 12）的病例中未确定。医源性损伤占26.2%（n = 66）。总体而言，46.0%（n = 16）的移植物被合理拒绝，25.0%（n = 63）被不合理拒绝，29.0%（n = 73）无法进行分析。总计36.9%的RNTK本可以进行移植。减少医源性损伤、提高显微外科修复技术以及进行适当的组织学检查对于减少RNTK的数量是必要的。应用所提出原则的前瞻性研究无疑对于完成这项工作至关重要。
