Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France.
Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France.
Am J Transplant. 2021 Jul;21(7):2424-2436. doi: 10.1111/ajt.16425. Epub 2021 Feb 18.
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
在循环死亡后控制供体捐献（cDCD）用于“扩展标准”供体，这些供体的肾脏移植效果较差。法国的 cDCD 计划于 2015 年启动，其特点是常温区域性灌注、低温机器灌注和较短的冷缺血时间。我们比较了 cDCD 和脑死亡（DBD）供体的肾脏移植结果，通过倾向评分匹配供体和受体特征，匹配 cDCD 和 DBD 肾脏移植。匹配过程保留了 499 例 cDCD 中的 442 例和 6185 例 DBD 中的 809 例。cDCD 受体的 DGF 发生率为 20%，而 DBD 受体为 28%（调整后的相对风险 [aRR]，1.43；95%置信区间 [CI]，1.12-1.82）。当按冷缺血时间和机器灌注使用对 DBD 移植进行排序并与 cDCD 移植进行比较时，无论冷缺血时间如何，未使用机器灌注的 DBD 移植的 DGF 的 aRR 更高（冷缺血时间<18 h 时的 aRR，1.57；95%CI，1.20-2.03，与冷缺血时间≥18 h 时的 aRR，1.79；95%CI，1.31-2.44）。两组的 1 年移植物存活率相似。根据该法国方案，cDCD 来源的肾脏移植的早期结果优于匹配的 DBD 移植。
