Yamauchi Junji, Raghavan Divya, Rofaiel George, Zimmerman Michael, Potluri Vishnu S, Baker Talia, Campsen Jeffrey, Hall Isaac E, Molnar Miklos Z
Division of Nephrology and Hypertension, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT.
Division of Transplantation and Advanced Hepatobiliary Surgery, Department of Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT.
Transplant Direct. 2023 Nov 2;9(12):e1554. doi: 10.1097/TXD.0000000000001554. eCollection 2023 Dec.
Therapeutic donors (TDs) are individuals who undergo organ removal for medical treatment with no replacement organ, and the organ is then transplanted into another person. Transplant centers in the United States have started using TDs for kidney transplantation (KT). TD-KT recipient outcomes may be inferior to those of non-TD-living-donor (non-TD-LD)-KT or deceased-donor (DD)-KT because of the conditions that led to nephrectomy; however, these outcomes have not been sufficiently evaluated.
This was a retrospective cohort study using Organ Procurement and Transplantation Network data. Via optimal matching methods, we created 1:4 fivesomes with highly similar characteristics for TD-KT and non-TD-LD-KT recipients and then separately for TD-KT and DD-KT recipients. We compared a 6-mo estimated glomerular filtration rate (eGFR) between groups (primary endpoint) and a composite of death, graft loss, or eGFR <30 mL/min/1.73 m at 6 mo (secondary).
We identified 36 TD-KT recipients with 6-mo eGFR. There was also 1 death and 2 graft losses within 6 mo. Mean ± SD 6-mo eGFR was not significantly different between TD-KT, non-TD-LD-KT, and DD-KT recipients (59.9 ± 20.7, 63.3 ± 17.9, and 59.9 ± 23.0 mL/min/1.73 m, respectively; > 0.05). However, the 6-mo composite outcome occurred more frequently with TD-KT than with non-TD-LD-KT and DD-KT (18%, 2% [ < 0.001], and 8% [ = 0.053], respectively).
Early graft function was no different between well-matched groups, but TD-KT demonstrated a higher risk of otherwise poor 6-mo outcomes compared with non-TD-LD-KT and DD-KT. Our results support selective utilization of TD kidneys; however, additional studies are needed with more detailed TD kidney information to understand how to best utilize these kidneys.
治疗性供体（TDs）是指那些接受器官切除用于治疗且无替代器官，随后该器官被移植给他人的个体。美国的移植中心已开始将治疗性供体用于肾移植（KT）。由于导致肾切除术的病情，治疗性供体肾移植（TD-KT）受者的结局可能不如非治疗性活体供体（non-TD-LD）肾移植（KT）或尸体供体（DD）肾移植（KT）受者；然而，这些结局尚未得到充分评估。
这是一项使用器官获取与移植网络数据的回顾性队列研究。通过最佳匹配方法，我们为TD-KT和非TD-LD-KT受者创建了特征高度相似的1:4五人组，然后分别为TD-KT和DD-KT受者创建了五人组。我们比较了组间6个月的估计肾小球滤过率（eGFR）（主要终点）以及6个月时死亡、移植物丢失或eGFR<30 mL/min/1.73 m²的复合结局（次要终点）。
我们确定了36例有6个月eGFR数据的TD-KT受者。6个月内还有1例死亡和2例移植物丢失。TD-KT、非TD-LD-KT和DD-KT受者的平均±标准差6个月eGFR无显著差异（分别为59.9±20.7、63.3±17.9和59.9±23.0 mL/min/1.73 m²；P>0.05）。然而，与非TD-LD-KT和DD-KT相比，TD-KT受者6个月的复合结局出现得更频繁（分别为18%、2%[P<0.001]和8%[P = 0.053]）。
在匹配良好的组中，早期移植物功能没有差异，但与非TD-LD-KT和DD-KT相比，TD-KT受者6个月时出现不良结局的风险更高。我们的结果支持对治疗性供体肾进行选择性利用；然而，需要更多关于治疗性供体肾详细信息的研究，以了解如何最佳利用这些肾脏。
