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荷兰心脏死亡后器官捐献过程中提取时间对移植后肾功能的影响。

Impact of Extraction Time During Donation After Circulatory Death Organ Procurement on Kidney Function After Transplantation in The Netherlands.

作者信息

van Straalen Erika, Rijkse Elsaline, van Staa AnneLoes, Rebers Paul M, Hagenaars Hanneke J A M, van de Wetering Jacqueline, Ijzermans Jan N M, Minnee Robert C

机构信息

Division of Hepatopancreatobiliary and Transplant Surgery, Department of Surgery, Erasmus Medical Center Transplant Institute, Rotterdam, The Netherlands.

Research Center Innovations in Care, Rotterdam University of Applied Sciences, The Netherlands.

出版信息

Transplant Direct. 2023 Oct 10;9(11):e1538. doi: 10.1097/TXD.0000000000001538. eCollection 2023 Nov.

DOI:10.1097/TXD.0000000000001538
PMID:37829246
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10566979/
Abstract

BACKGROUND

In The Netherlands, 60% of deceased-donor kidney offers are after donation after circulatory death. Cold and warm ischemia times are known risk factors for delayed graft function (DGF) and inferior allograft survival. Extraction time is a relatively new ischemia time. During procurement, cooling of the kidneys is suboptimal with ongoing ischemia. However, evidence is lacking on whether extraction time has an impact on DGF if all ischemic periods are included.

METHODS

Between 2012 and 2018, 1524 donation after circulatory death kidneys were procured and transplanted in The Netherlands. Donation and transplantation-related data were obtained from the database of the Dutch Transplant Foundation. The primary outcome parameter was the incidence of DGF.

RESULTS

In our cohort, extraction time ranged from 14 to 237 min, with a mean of 62 min (SD 32). In multivariate logistic regression analysis, extraction time was an independent risk factor for incidence of DGF (odds ratio per minute increase 1.008; 95% confidence interval, 1.003-1.013;  = 0.001). The agonal phase, hypoperfusion time, and anastomosis time were not independent risk factors for incidence of DGF.

CONCLUSIONS

Considering all known ischemic periods during the donation after the circulatory death process, prolonged kidney extraction time increased the risk of DGF after kidney transplantation.

摘要

背景

在荷兰，60%的死亡供体肾脏供体是在循环死亡后捐赠的。冷缺血时间和热缺血时间是已知的移植肾功能延迟（DGF）和移植肾存活率较低的危险因素。摘取时间是一个相对较新的缺血时间。在获取过程中，肾脏的冷却并不理想，缺血仍在持续。然而，如果将所有缺血期都包括在内，关于摘取时间是否对DGF有影响尚缺乏证据。

方法

2012年至2018年期间，在荷兰获取并移植了1524例循环死亡后捐赠的肾脏。捐赠和移植相关数据来自荷兰移植基金会的数据库。主要结局参数是DGF的发生率。

结果

在我们的队列中，摘取时间为14至237分钟，平均为62分钟（标准差32）。在多因素逻辑回归分析中，摘取时间是DGF发生率的独立危险因素（每分钟增加的比值比为1.008；95%置信区间，1.003 - 1.013；P = 0.001）。濒死期、低灌注时间和吻合时间不是DGF发生率的独立危险因素。

结论

考虑到循环死亡后捐赠过程中的所有已知缺血期，延长肾脏摘取时间会增加肾移植后发生DGF的风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/b0d1a9ccd190/txd-9-e1538-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/1aa7e9462281/txd-9-e1538-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/7a00c4d75a49/txd-9-e1538-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/60ad59158ab1/txd-9-e1538-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/eef4971e4358/txd-9-e1538-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/b0d1a9ccd190/txd-9-e1538-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/1aa7e9462281/txd-9-e1538-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/7a00c4d75a49/txd-9-e1538-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/60ad59158ab1/txd-9-e1538-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/eef4971e4358/txd-9-e1538-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf3b/10566979/b0d1a9ccd190/txd-9-e1538-g005.jpg

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Safety and feasibility of 2 h of normothermic machine perfusion of donor kidneys in the Eurotransplant Senior Program.在 Eurotransplant Senior 项目中，供肾 2 小时常温机器灌注的安全性和可行性。
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa024.
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