Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
NHS Blood and Transplant, Bristol, UK.
Ann Surg. 2021 Nov 1;274(5):859-865. doi: 10.1097/SLA.0000000000005123.
To assess the impact of CIT on living donor kidney transplantation (LDKT) outcomes in the UKLKSS versus outside the scheme.
LDKT provides the best treatment option for end-stage kidney disease patients. end-stage kidney disease patients with an incompatible living donor still have an opportunity to be transplanted through Kidney Exchange Programmes (KEP). In KEPs where kidneys travel rather than donors, cold ischaemia time (CIT) can be prolonged.
Data from all UK adult LDKT between 2007 and 2018 were analysed.
9969 LDKT were performed during this period, of which 1396 (14%) were transplanted through the UKLKSS, which we refer to as KEP. Median CIT was significantly different for KEP versus non-KEP (339 versus 182 minutes, P < 0.001). KEP LDKT had a higher incidence of delayed graft function (DGF) (2.91% versus 5.73%, P < 0.0001), lower 1-year (estimated Glomerular Filtration Rate (eGFR) 57.90 versus 55.25 ml/min, P = 0.04) and 5-year graft function (eGFR 55.62 versus 53.09 ml/min, P = 0.01) compared to the non-KEP group, but 1- and 5-year graft survival were similar. Within KEP, a prolonged CIT was associated with more DGF (3.47% versus 1.95%, P = 0.03), and lower graft function at 1 and 5-years (eGFR = 55 vs 50 ml/min, P = 0.02), but had no impact on graft survival.
Whilst CIT was longer in KEP, associated with more DGF and lower graft function, excellent 5-year graft survival similar to non-KEP was found.
评估 CIT 对英国器官共享联合署（UKLKSS）与方案外活体供肾移植（LDKT）结果的影响。
LDKT 为终末期肾病患者提供了最佳的治疗选择。对于配型不合适的活体供者，仍有机会通过肾脏交换计划（KEP）进行移植。在肾脏转运而非供者转运的 KEP 中，冷缺血时间（CIT）可能会延长。
分析了 2007 年至 2018 年期间所有英国成人 LDKT 的数据。
在此期间进行了 9969 例 LDKT，其中 1396 例（14%）通过 Uklkss（我们称之为 KEP）进行移植。KEP 与非 KEP 的中位 CIT 差异显著（339 分钟比 182 分钟，P<0.001）。KEP LDKT 的延迟移植物功能障碍（DGF）发生率较高（2.91%比 5.73%，P<0.0001），1 年（估计肾小球滤过率（eGFR）57.90 毫升/分钟比 55.25 毫升/分钟，P=0.04）和 5 年移植物功能（eGFR 55.62 毫升/分钟比 53.09 毫升/分钟，P=0.01）均较低，但 1 年和 5 年移植物存活率相似。在 KEP 中，较长的 CIT 与更多的 DGF 相关（3.47%比 1.95%，P=0.03），1 年和 5 年时的移植物功能较低（eGFR=55 毫升/分钟比 50 毫升/分钟，P=0.02），但对移植物存活率没有影响。
尽管 KEP 的 CIT 较长，与更多的 DGF 和较低的移植物功能相关，但发现其 5 年移植物存活率与非 KEP 相似。
