日本心脏死亡后捐献供肾移植的风险因素分析。
Analysis of risk factors for donation after circulatory death kidney transplantation in Japan.
机构信息
Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
The Japanese Renal Transplant Registry, Japanese Society for Clinical Renal Transplantation, Tokyo, Japan.
出版信息
Clin Exp Nephrol. 2022 Jan;26(1):86-94. doi: 10.1007/s10157-021-02128-2. Epub 2021 Aug 26.
BACKGROUND
In Japan, donations after circulatory death kidney transplantation are widely performed due to legislation delays. The number of donations after brain death kidney transplantations is increasing, but the target remains unmet. We reviewed the outcomes of donation after circulatory death in Japan.
METHODS
We analyzed 2923 deceased kidney transplantations (2239: donation after circulatory death (DCD), 684: donation after brain death (DBD)) performed in Japan from 2000 to 2019. The outcomes of the DCD and DBD groups were compared. We examined the risk factors for graft loss in the DCD group.
RESULTS
The 5-year patient survival and death-censored graft survival rates of the DCD group, obtained by propensity score matching, were 93.6% and 95.2%, respectively, which were equivalent to 94.2% and 93.8%, respectively, obtained in the DBD group. Older donors (≥ 50 years) and prolonged cold ischemia time (≥ 12 h) were risk factors for graft loss; in the presence of these, graft survival was lower in the DCD group.
CONCLUSIONS
Older donors and prolonged cold ischemia time reduced graft survival in the DCD group. Proper evaluation of donors and careful preparation for transplant surgery are, therefore, essential to ensure good transplant outcomes.
背景
在日本，由于立法延迟，广泛开展了循环死亡后的器官捐献肾脏移植。脑死亡后肾脏移植的数量正在增加，但仍未达到目标。我们回顾了日本循环死亡后的器官捐献结果。
方法
我们分析了 2000 年至 2019 年在日本进行的 2923 例已故肾脏移植（2239 例：循环死亡后捐献（DCD），684 例：脑死亡后捐献（DBD））。比较了 DCD 组和 DBD 组的结果。我们检查了 DCD 组移植物丢失的风险因素。
结果
通过倾向评分匹配获得的 DCD 组的 5 年患者生存率和死亡风险校正移植物生存率分别为 93.6%和 95.2%，与 DBD 组的 94.2%和 93.8%相当。年龄较大的供体（≥50 岁）和较长的冷缺血时间（≥12 小时）是移植物丢失的风险因素；在这些情况下，DCD 组的移植物存活率较低。
结论
年龄较大的供体和较长的冷缺血时间降低了 DCD 组的移植物存活率。因此，对供体进行适当的评估和仔细准备移植手术对于确保良好的移植结果至关重要。
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