非理想供体合并急性肾损伤的肾移植单中心经验及文献综述：风险与获益
Single center experience and literature review of kidney transplantation from non-ideal donors with acute kidney injury: Risk and reward.
作者信息
Webb Christopher J, McCracken Emily, Jay Colleen L, Sharda Berjesh, Garner Matthew, Farney Alan C, Orlando Giuseppe, Reeves-Daniel Amber, Mena-Gutierrez Alejandra, Sakhovskaya Natalia, Stratta Bobby, Stratta Robert J
机构信息
Department of Surgery, Section of Transplantation and the Section of Nephrology, Winston-Salem, North Carolina, USA.
Department of Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
出版信息
Clin Transplant. 2023 Oct;37(10):e15115. doi: 10.1111/ctr.15115. Epub 2023 Aug 30.
INTRODUCTION
There is limited experience transplanting kidneys from either expanded criteria donors (ECD) or donation after circulatory death (DCD) deceased donors with terminal acute kidney injury (AKI).
METHODS
AKI kidneys were defined by a donor terminal serum creatinine level >2.0 mg/dL whereas non-ideal deceased donor (NIDD) kidneys were defined as AKI/DCD or AKI/ECDs.
RESULTS
From February 2007 to March 2023, we transplanted 266 single AKI donor kidneys including 29 from ECDs, 29 from DCDs (n = 58 NIDDs), and 208 from brain-dead standard criteria donors (SCDs). Mean donor age (43.7 NIDD vs. 33.5 years SCD), KDPI (66% NIDD vs. 45% SCD), and recipient age (57 NIDD vs. 51 years SCD) were higher in the NIDD group (all p < .01). Mean waiting times (17.8 NIDD vs. 24.2 months SCD) and dialysis duration (34 NIDD vs. 47 months SCD) were shorter in the NIDD group (p < .05). Delayed graft function (DGF, 48%) and 1-year graft survival (92.7% NIDD vs. 95.9% SCD) was similar in both groups. Five-year patient and kidney graft survival rates were 82.1% versus 89.9% and 82.1% versus 75.2% (both p = NS) in the NIDD versus SCD groups, respectively.
CONCLUSIONS
The use of kidneys from AKI donors can be safely liberalized to include selected ECD and DCD donors.
引言
对于使用扩大标准供体（ECD）或循环死亡后捐赠（DCD）的终末期急性肾损伤（AKI）死亡供体的肾脏进行移植，相关经验有限。
方法
AKI肾脏定义为供体终末期血清肌酐水平>2.0mg/dL，而非理想死亡供体（NIDD）肾脏定义为AKI/DCD或AKI/ECD。
结果
2007年2月至2023年3月，我们共移植了266个单肾AKI供体肾脏，其中29个来自ECD，29个来自DCD（共58个NIDD），208个来自脑死亡标准供体（SCD）。NIDD组的供体平均年龄（43.7岁对SCD组的33.5岁）、肾脏分配积分（KDPI，66%对SCD组的45%）和受者年龄（57岁对SCD组的51岁）均更高（均p<0.01）。NIDD组的平均等待时间（17.8个月对SCD组的24.2个月）和透析时间（34个月对SCD组的47个月）更短（p<0.05）。两组的移植肾功能延迟恢复（DGF，48%）和1年移植肾存活率（NIDD组为92.7%对SCD组的95.9%）相似。NIDD组与SCD组的5年患者和移植肾存活率分别为82.1%对89.9%和82.1%对75.2%（均p=无显著性差异）。
结论
可以安全地放宽对AKI供体肾脏的使用范围，将选定的ECD和DCD供体纳入其中。
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