Slagter Julia S, Kimenai Hendrikus J A N, van de Wetering Jacqueline, Hagenaars Hanneke J A M, Reinders Marlies E J, Polak Wojciech G, Porte Robert J, Minnee Robert C
Division of Hepatobiliary and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Rotterdam, the Netherlands.
Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus MC Transplant Institute, Rotterdam, the Netherlands.
JAMA Surg. 2024 Dec 1;159(12):1347-1353. doi: 10.1001/jamasurg.2024.3913.
In the Netherlands, organ donation after euthanasia (donation after circulatory death type V [DCD-V]) has been increasingly performed since 2012. However, the outcomes of DCD-V kidney grafts have not been thoroughly investigated. It is critical to assess the outcomes of these kidney grafts to ascertain whether DCD-V is a safe and valuable way to increase the kidney donor pool.
To investigate the outcomes of DCD-V kidney transplantation and compare them with outcomes of kidney transplantation after circulatory death after withdrawal of life-sustaining therapies (DCD type III [DCD-III]) and donation after brain death (DBD).
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using the database from the Dutch Transplant Foundation. All kidney transplants in the Netherlands between January 2012 (start of the euthanasia program) and July 2023 were included. Follow-up was obtained through 5 years after transplantation. Data analysis was performed from November 2023 until February 2024.
Kidney transplantation with a DCD-V graft compared with DCD-III and DBD grafts.
The primary outcome was death-censored graft survival until 5 years after transplantation. Secondary outcomes were the incidence of delayed graft function (DGF), permanent nonfunction (PNF), serum creatinine concentration, and patient survival until 5 years after kidney transplantation.
A total of 145 DCD-V kidney transplants were compared with 1936 DCD-III and 1255 DBD kidney transplants. Median (IQR) recipient age was 59 (46-66) years in the DCD-V cohort, compared with 61 (50-68) years in the DCD-III cohort and 61 (50-68) years in the DBD cohort. The incidence of DGF with DCD-V kidney transplants (26%) was significantly less than that with DCD-III kidney transplants (49%; P < .001) and similar to that with DBD kidney transplants (22%; P = .46). PNF occurrence with DCD-V kidneys (6%) was similar to that with DCD-III kidneys (6%; P = .79) and higher than in DBD kidneys (4%; P < .001). There was no difference in 5-year death-censored graft survival between DCD-V grafts (82%) and DCD-III (86%; P = .99) or DBD (84%; P = .99) grafts. There was no difference in 5-year patient survival between DCD-V kidney transplants (69%) and DCD-III (76%; P = .45) or DBD (73%; P = .74) kidney transplants. A propensity score analysis was performed to match the DCD-V and DCD-III cohort, showing results similar to those of the unmatched cohort.
This study found that DCD-V kidney transplantation yielded a lower incidence of DGF compared with DCD-III kidney transplantation and yielded long-term results similar to those of DCD-III and DBD kidney transplantation. The findings suggest that DCD-V is a safe and valuable way to increase the kidney donor pool.
在荷兰，自2012年以来，安乐死之后的器官捐赠（循环死亡后类型V [DCD-V]捐赠）越来越多。然而，DCD-V肾移植的结果尚未得到充分研究。评估这些肾移植的结果对于确定DCD-V是否是增加肾供体库的一种安全且有价值的方式至关重要。
研究DCD-V肾移植的结果，并将其与撤除维持生命治疗后的循环死亡后肾移植（DCD类型III [DCD-III]）及脑死亡后捐赠（DBD）的结果进行比较。
设计、设置和参与者：使用荷兰移植基金会的数据库进行了一项回顾性队列研究。纳入了2012年1月（安乐死项目开始）至2023年7月荷兰的所有肾移植。随访时间为移植后5年。数据分析于2023年11月至2024年2月进行。
与DCD-III和DBD移植物相比，采用DCD-V移植物进行肾移植。
主要结局是移植后5年的死亡删失移植物存活情况。次要结局包括延迟性移植物功能恢复（DGF）的发生率、永久性无功能（PNF）、血清肌酐浓度以及肾移植后5年的患者存活情况。
共对145例DCD-V肾移植与1936例DCD-III肾移植及1255例DBD肾移植进行了比较。DCD-V队列中受者的年龄中位数（四分位间距）为59（46 - 66）岁，DCD-III队列中为61（50 - 68）岁，DBD队列中为61（50 - 68）岁。DCD-V肾移植的DGF发生率（26%）显著低于DCD-III肾移植（49%；P < 0.001），与DBD肾移植（22%；P = 0.46）相似。DCD-V肾的PNF发生率（6%）与DCD-III肾（6%；P = 0.79）相似，高于DBD肾（4%；P < 0.001）。DCD-V移植物（82%）与DCD-III移植物（86%；P = 0.99）或DBD移植物（84%；P = 0.99）的5年死亡删失移植物存活情况无差异。DCD-V肾移植（69%）与DCD-III肾移植（76%；P = 0.45）或DBD肾移植（73%；P = 0.74）的5年患者存活情况无差异。进行了倾向评分分析以匹配DCD-V和DCD-III队列，结果与未匹配队列相似。
本研究发现，与DCD-III肾移植相比，DCD-V肾移植的DGF发生率较低，且长期结果与DCD-III和DBD肾移植相似。研究结果表明，DCD-V是增加肾供体库的一种安全且有价值的方式。
