González-Segura C, Castelao A M, Torras J, Moreso F, Riera L, López-Costea M A, Pascual M, Grinyó J M, Alsina J
Department of Transplant Coordination, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Transplantation. 1998 Jun 15;65(11):1465-70. doi: 10.1097/00007890-199806150-00010.
Because of the shortage of kidneys available for transplantation, we began in 1985 to harvest kidneys from non-heartbeating (NHB) donors.
We compared the results of a group of 66 kidney recipients from NHB donors (NHB group) with 122 kidney recipients from heartbeating donors (HB group). We analyzed, in the NHB group, the influence of ischemia times in graft survival and we tested the best cut-offs by receiver operating characteristic curves. We also studied, using a univariate and multivariate Cox hazard model, the capacity of different variables to predict graft loss.
Patient and graft survival were similar in both groups during the follow-up. The percentage of delayed graft function was the only significant difference between both groups (NHB group 62% vs. HB group 32%; P=0.0001). Delayed graft function, in the NHB group, is influenced by the warm ischemia time, which is directly related to the number of days to achieve a serum creatinine<300 mmol/L (P=0.0001). The best cut-off times in this group were 45 min for warm ischemia time and 22 hr for cold ischemia time. Recipients have a greater likelihood of losing the graft beyond those limits (P=0.017, relative risk: 7.3). The incidence of acute rejection was similar in both groups, and it was the only predictor factor of graft loss in the complete series of patients (P=0.0001), in the NHB group (P=0.007), and in the HB group (P=0.02).
Reducing the incidence of acute rejection and shortening ischemia time are conditions needed to guarantee a long graft survival of kidneys from NHB donors.
由于可用于移植的肾脏短缺，我们于1985年开始从非心跳供体（NHB）获取肾脏。
我们将一组66例接受NHB供体肾脏移植的受者（NHB组）的结果与122例接受心跳供体肾脏移植的受者（HB组）的结果进行了比较。在NHB组中，我们分析了缺血时间对移植物存活的影响，并通过受试者工作特征曲线测试了最佳截断值。我们还使用单变量和多变量Cox风险模型研究了不同变量预测移植物丢失的能力。
随访期间两组患者和移植物的存活率相似。移植肾功能延迟的发生率是两组之间唯一的显著差异（NHB组62% vs. HB组32%；P = 0.0001）。在NHB组中，移植肾功能延迟受热缺血时间的影响，热缺血时间与血清肌酐<300 mmol/L所需天数直接相关（P = 0.0001）。该组的最佳截断时间为热缺血时间45分钟和冷缺血时间22小时。超过这些限制，受者失去移植物的可能性更大（P = 0.017，相对风险：7.3）。两组急性排斥反应的发生率相似，并且在整个患者系列中（P = 0.0001）、NHB组（P = 0.007）和HB组（P = 0.02），急性排斥反应是移植物丢失的唯一预测因素。
降低急性排斥反应的发生率和缩短缺血时间是保证NHB供体肾脏长期移植物存活的必要条件。
