Westmead Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia.
Department of Surgery, Westmead Hospital, Sydney, NSW, Australia.
Transplantation. 2024 Jun 1;108(6):1422-1429. doi: 10.1097/TP.0000000000004937. Epub 2024 Feb 16.
Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD).
MEDLINE, Cochrane, and Embase databases were searched. Data on demographic information and transplant outcomes were extracted from included studies. Meta-analyses were performed, and risk ratios (RR) were estimated to compare transplant outcomes from uDCD to cDCD.
Nine cohort studies were included, from 2178 uDCD kidney transplants. There was a moderate degree of bias, as 4 studies did not account for potential confounding factors. The median incidence of primary nonfunction in uDCD was 12.3% versus 5.7% for cDCD (RR, 1.85; 95% confidence intervals, 1.06-3.23; P = 0.03, I 2 = 75). The median rate of delayed graft function was 65.1% for uDCD and 52.0% for cDCD. The median 1-y graft survival for uDCD was 82.7% compared with 87.5% for cDCD (RR, 1.43; 95% confidence intervals, 1.02-2.01; P = 0.04; I 2 = 71%). The median 5-y graft survival for uDCD and cDCD was 70% each. Notably, the use of normothermic regional perfusion improved primary nonfunction rates in uDCD grafts.
Although uDCD outcomes may be inferior in the short-term, the long-term outcomes are comparable to cDCD.
未控制性循环死亡后捐献（uDCD）是潜在的额外供肾来源。本研究回顾了 uDCD 肾移植的结局，以确定其是否与控制性循环死亡后捐献（cDCD）相当。
检索 MEDLINE、Cochrane 和 Embase 数据库。从纳入的研究中提取人口统计学信息和移植结局数据。进行了荟萃分析，并估计风险比（RR）以比较 uDCD 与 cDCD 的移植结局。
纳入了 9 项队列研究，涉及 2178 例 uDCD 肾移植。由于 4 项研究未考虑潜在的混杂因素，存在中度偏倚。uDCD 中原发性无功能的中位发生率为 12.3%，而 cDCD 为 5.7%（RR，1.85；95%置信区间，1.06-3.23；P = 0.03，I 2 = 75）。uDCD 的延迟移植物功能发生率的中位值为 65.1%，cDCD 为 52.0%。uDCD 的 1 年移植物存活率的中位值为 82.7%，而 cDCD 为 87.5%（RR，1.43；95%置信区间，1.02-2.01；P = 0.04；I 2 = 71%）。uDCD 和 cDCD 的 5 年移植物存活率中位数均为 70%。值得注意的是，使用常温区域灌注可提高 uDCD 移植物的原发性无功能发生率。
尽管 uDCD 的短期结局可能较差，但长期结局与 cDCD 相当。
