Pinho Ana, Sampaio Susana, Alencastre Inês, Polidoro Maria João, Rios Margarida, Roncon-Albuquerque Roberto, Silva João, Silva Carlos, Pestana Manuel
Centro de Referência de Transplante Renal - Adultos, Unidade Local de Saúde São João EPE, Porto, Portugal.
Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Transpl Int. 2025 Aug 26;38:14651. doi: 10.3389/ti.2025.14651. eCollection 2025.
In January 2016, our hospital started a program of uncontrolled donation after circulatory death (uDCD) to increase organ availability for kidney transplantation. We analysed the results of 523 consecutive kidney transplants (KT) performed from January 2016 to December 2023 in our center and compared the outcomes of 142 KT from uDCD maintained by abdominal normothermic regional perfusion (A-NRP) with those from 194 KT from standard-criteria brain-death donors (SCD) and 187 KT from expanded-criteria brain-death donors (ECD). Primary non-function (PNF) was similar in uDCD (16.9%) and ECD (13.4%, 0.460) and more common than in SCD (4.6%; 0.001). In addition, delayed graft function (DGF) differed among the groups, being higher in the uDCD (69.7%), followed by ECD (43.9%) and SCD (37.6%; ≤ 0.05). However, the estimated glomerular filtration rate (eGFR) at 7 years was similar in uDCD and SCD (62.27 ± 18.38 mL/min/1.73 m vs. 65.48 ± 19.24 mL/min/1.73 m, = 1) and higher than in ECD (47.67 ± 23.05 mL/min/1.73 m, < 0.001). When excluding PNF, the 7-year death-censored graft survival was similar among the three groups (SCD, 91.4%; uDCD, 96.2%; ECD, 82.7%). Despite the increased risk of PNF and DGF, functional and survival outcomes of uDCD KT at 7 years were comparable to those of SCD, thus supporting the use of uDCD kidneys maintained under A-NRP as a successful resource to address organ scarcity.
2016年1月，我院启动了一项心脏死亡后非控制性捐赠（uDCD）项目，以增加肾移植的器官供应。我们分析了2016年1月至2023年12月在我院中心连续进行的523例肾移植（KT）的结果，并比较了142例通过腹部常温区域灌注（A-NRP）维持的uDCD肾移植与194例标准标准脑死亡供体（SCD）肾移植和187例扩大标准脑死亡供体（ECD）肾移植的结果。原发性无功能（PNF）在uDCD组（16.9%）和ECD组（13.4%，P = 0.460）中相似，且比SCD组（4.6%；P < 0.001）更常见。此外，移植肾功能延迟恢复（DGF）在各组之间存在差异，uDCD组（69.7%）最高，其次是ECD组（43.9%）和SCD组（37.6%；P ≤ 0.05）。然而，uDCD组和SCD组7年时的估计肾小球滤过率（eGFR）相似（62.27±18.38 mL/min/1.73m² 对 65.48±19.24 mL/min/1.73m²，P = 1），且高于ECD组（47.67±23.05 mL/min/1.73m²，P < 0.001）。排除PNF后，三组的7年死亡截尾移植肾存活率相似（SCD组为91.4%；uDCD组为96.2%；ECD组为82.7%）。尽管PNF和DGF的风险增加，但uDCD肾移植7年时的功能和存活结果与SCD组相当，因此支持将在A-NRP下维持的uDCD肾脏作为解决器官短缺的成功资源加以利用。
