Nephrology Department, Hospital del Mar, Barcelona, Spain.
Nephrology Department, Hospital Germans Trias i Pujol, Badalona, Spain.
Transpl Int. 2021 Dec;34(12):2507-2514. doi: 10.1111/tri.14141. Epub 2021 Nov 11.
The number of kidney transplant (KT) procedures with controlled donation after circulatory death (cDCD) donors has exponentially increased in Spain in recent years, with a parallel increase in donor and recipient acceptance criteria. The outcomes of cDCD-KT have been reported to be comparable to those of KT with donation after brain death (DBD) donors. However, studies in elderly recipients have yielded contradictory results. We performed a registry analysis of 852 KT recipients aged ≥65 years (575 in the DBD-KT group, 277 in the cDCD-KT group) in Catalonia, Spain. Clinical outcomes and survival were compared between DBD-KT and cDCD-KT recipients. The donor and recipient ages were similar between the two groups (71.5 ± 8.7 years for donors, 70.8 ± 4.1 years for recipients). Delayed graft function (DGF) was more frequent among cDCD-KT recipients, without a difference in the rate of primary nonfunction. The 3-year patient and death-censored graft survival rates were similar between DBD-KT and cDCD-KT recipients (78.8% vs. 76.4% and 90.3% vs. 86.6%, respectively). In multivariable analysis, previous cardiovascular disease and DGF were independent risk factors for patient death. The type of donation (cDCD vs. DBD) was not an independent risk factor for patient survival or graft loss. cDCD-KT and DBD-KT provide comparable patient and graft survival in elderly recipients.
近年来，西班牙接受循环死亡后控制供体（cDCD）的肾移植（KT）手术数量呈指数级增长，同时供体和受者的接受标准也有所提高。cDCD-KT 的结果已被报道与脑死亡后供体（DBD）的 KT 结果相当。然而，在老年受者中的研究结果却存在矛盾。我们对西班牙加泰罗尼亚地区 852 名年龄≥65 岁的 KT 受者（DBD-KT 组 575 例，cDCD-KT 组 277 例）进行了登记分析。比较了 DBD-KT 和 cDCD-KT 受者的临床结果和存活率。两组供者和受者的年龄相似（供者为 71.5±8.7 岁，受者为 70.8±4.1 岁）。cDCD-KT 受者更常发生延迟移植物功能（DGF），但原发性无功能的发生率无差异。DBD-KT 和 cDCD-KT 受者的 3 年患者和死亡无病存活率相似（分别为 78.8%对 76.4%和 90.3%对 86.6%）。多变量分析显示，既往心血管疾病和 DGF 是患者死亡的独立危险因素。供体类型（cDCD 与 DBD）不是患者生存或移植物丢失的独立危险因素。cDCD-KT 和 DBD-KT 可为老年受者提供相似的患者和移植物存活率。
