Swisstransplant, Bern, Switzerland.
University of Zurich Faculty of Medicine, Zurich, Switzerland.
Swiss Med Wkly. 2022 Feb 18;152:w30139. doi: 10.4414/smw.2022.w30132. eCollection 2022 Feb 14.
Organ donation after circulatory death (DCD) was reintroduced in Switzerland in 2011 and accounts for a third of deceased organ donors today. Controversy persists if DCD transplants are of similar quality to transplants following donation after brain death (DBD), mainly due to warm ischaemia time DCD organs are exposed to. We compared DCD with DBD in Switzerland.
Data on deceased adults who were referred to and approved for organ donation from 1 September 2011 to 31 December 2019 were retrospectively analysed (217 DCD, 840 DBD donors). We compared DCD and DBD donor/organ characteristics, transplant rates of lungs, liver, kidneys, and pancreas, and early liver and kidney graft function in the recipient. The effect of DCD/DBD on transplant rates (organ transplanted or not) and 72-hour recipient graft function (moderate/good vs delayed graft function / organ loss) was analysed using multivariable logistic regression. Among utilised DCD donors, we analysed the effect of functional warm ischaemia time (FWIT) and donor age on 72-hour post-transplant liver and kidney graft function, also using multivariable logistic regression.
DCD donors were more often male (64.5% vs 56.8% p = 0.039), presented with heart disease (36.4% vs 25.5%, p <0.001), were resuscitated before hospital admission (41.9% vs 30.7%, p = 0.006), and died from anoxia (41.9% vs 23.9%). Kidney function before transplantation was comparable, lung, liver and pancreas function were poorer in DCD than DBD. Eighty-one and 91% of approved DCD and DBD donors were utilised (p <0.001). Median FWIT in DCD was 29 minutes (interquartile range 25-35). DCD transplant rates ranged from 4% (pancreas) to 73% (left kidney) and were all lower compared with DBD. Seventy-two-hour liver graft function was comparable between DCD and DBD (94.2% vs 96.6% moderate/good, p = 0.199). DCD kidney transplants showed increased risk of delayed graft function or early organ loss (odds ratios 8.32 and 5.05; 95% confidence intervals CI 5.28-13.28 and 3.22-7.95; both p <0.001, for left and right kidney transplants, respectively). No negative effect of prolonged FWIT or higher donor age was detected.
Despite less favourable donor/organ characteristics compared with donation after brain death, donation after circulatory death donors are increasingly referred and today provide an important source for scarce transplants in Switzerland. We identified a higher risk for delayed graft function or early organ loss for DCD kidney transplants, but not for DCD liver transplants. When carefully selected and allowed for other risk factors in organ allocation, prolonged functional warm ischaemia time or higher age in donation after circulatory death does not seem to be associated with impaired graft function early after transplantation.
在瑞士，心脏死亡后器官捐献（DCD）于 2011 年重新引入，目前占已故器官捐献者的三分之一。DCD 移植的质量是否与脑死亡后捐献（DBD）相似，仍存在争议，主要是因为 DCD 器官在经历热缺血时间时会受到影响。我们比较了瑞士的 DCD 和 DBD。
回顾性分析了 2011 年 9 月 1 日至 2019 年 12 月 31 日期间被推荐并批准进行器官捐献的成年死者的数据（217 例 DCD，840 例 DBD 捐献者）。我们比较了 DCD 和 DBD 捐献者/器官的特征、肺、肝、肾和胰腺的移植率，以及受体中肝和肾移植物的早期功能。使用多变量逻辑回归分析 DCD/DBD 对移植率（是否移植器官）和 72 小时受体移植物功能（中度/良好与延迟移植物功能/器官丧失）的影响。在使用的 DCD 捐献者中，我们还使用多变量逻辑回归分析了功能热缺血时间（FWIT）和供体年龄对 72 小时肝、肾移植后功能的影响。
DCD 捐献者中男性（64.5%比 56.8%，p = 0.039）更多，患有心脏病（36.4%比 25.5%，p <0.001），在入院前接受过复苏（41.9%比 30.7%，p = 0.006），并因缺氧而死亡（41.9%比 23.9%）。移植前的肾功能相当，但 DCD 的肺、肝和胰腺功能均比 DBD 差。81%和 91%的批准 DCD 和 DBD 捐献者得到了利用（p <0.001）。DCD 的中位 FWIT 为 29 分钟（四分位距 25-35）。DCD 的移植率从 4%（胰腺）到 73%（左肾）不等，均低于 DBD。72 小时肝移植物功能在 DCD 和 DBD 之间相当（94.2%中度/良好比 96.6%，p = 0.199）。DCD 肾移植的延迟移植物功能或早期器官丧失的风险增加（比值比 8.32 和 5.05；95%置信区间 5.28-13.28 和 3.22-7.95；均 p <0.001，左肾和右肾移植）。未发现延长 FWIT 或更高供体年龄的负面作用。
尽管与脑死亡后捐献相比，DCD 捐献者的捐献者/器官特征较差，但越来越多的 DCD 捐献者被推荐，目前在瑞士为稀缺的移植提供了重要来源。我们发现 DCD 肾移植的延迟移植物功能或早期器官丧失的风险较高，但 DCD 肝移植没有这种风险。当在器官分配中仔细选择并考虑其他风险因素时，DCD 中的延长功能热缺血时间或较高年龄似乎不会导致移植后早期移植物功能受损。
