Division of Transplant Surgery, Department of Surgery, University of California Davis Health, Sacramento, California, USA.
Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California, USA.
Clin Transplant. 2024 Aug;38(8):e15436. doi: 10.1111/ctr.15436.
Efforts to address the shortage of donor organs include increasing the use of renal allografts from donors after circulatory death (DCD). While warm ischemia time (WIT) is thought to be an important factor in DCD kidney evaluation, few studies have compared the relationship between WIT and DCD kidney outcomes, and WIT acceptance practices remain variable.
We conducted a single-center retrospective review of all adult patients who underwent deceased donor kidney transplantation from 2000 to 2021. We evaluated the impact of varied functional warm ischemia time (fWIT) in controlled DCD donors by comparing donor and recipient characteristics and posttransplant outcomes between high fWIT (>60 min), low fWIT (≤60 min), and kidneys transplanted from donors after brain death (DBD).
Two thousand eight hundred eleven patients were identified, 638 received low fWIT DCD, 93 received high fWIT DCD, and 2080 received DBD kidneys. There was no significant difference in 5-year graft survival between the DCD low fWIT, high fWIT, and DBD groups, with 84%, 83%, and 83% of grafts functioning, respectively. Five-year patient survival was 91% in the low fWIT group, 92% in the high fWIT group, and 90% in the DBD group. An increase in kidney donor risk index (KDRI) (HR 3.37, 95% CI = 2.1-5.7) and high CIT compared to low CIT (HR 2.12, 95% CI = 1.4-3.1) have higher hazard ratios for 1-year graft failure.
Increased acceptance of kidneys from selected DCD donors with prolonged fWIT may present an opportunity to increase kidney utilization while preserving outcomes. Our group specifically prioritizes the use of kidneys from younger donors, with lower KDPI, and without acute kidney injury, or risk factors for underlying chronic kidney disease.
为了解决供体器官短缺的问题，人们正在努力增加使用来自脑死亡供体（DBD）以外的死亡后循环供体（DCD）的肾移植。虽然热缺血时间（WIT）被认为是 DCD 肾脏评估的一个重要因素，但很少有研究比较 WIT 与 DCD 肾脏结局之间的关系，而且 WIT 接受实践仍然存在差异。
我们对 2000 年至 2021 年间所有接受过已故供体肾移植的成年患者进行了单中心回顾性研究。我们通过比较高功能 WIT（>60 分钟）、低功能 WIT（≤60 分钟）和 DBD 供体的供体和受者特征以及移植后结局，评估了控制下 DCD 供体中不同功能 WIT 的影响。
确定了 2811 例患者，其中 638 例接受了低 WIT DCD，93 例接受了高 WIT DCD，2080 例接受了 DBD 肾脏。低 WIT DCD、高 WIT DCD 和 DBD 组之间 5 年移植物存活率无显著差异，分别有 84%、83%和 83%的移植物功能正常。低 WIT DCD 组、高 WIT DCD 组和 DBD 组的 5 年患者存活率分别为 91%、92%和 90%。与低 CIT 相比，肾供体风险指数（KDRI）增加（HR 3.37，95%CI=2.1-5.7）和高 CIT（HR 2.12，95%CI=1.4-3.1）的患者 1 年内移植物失功的风险比更高。
接受选择的 WIT 延长的 DCD 供体的肾脏可能会增加肾脏的利用率，同时保持结果。我们小组特别优先考虑使用来自年轻供体的肾脏，这些供体的 KDPI 较低，没有急性肾损伤或潜在慢性肾脏病的危险因素。
