Abstract：
The increase in the number of patients on the kidney transplant waiting list has led to an attempt to increase the number of potential donors by incorporating candidates that previously would not have been considered optimal, including donors after cardiac death (DCD) and those with \"expanded\" criteria (ECD). Recipients of controlled DCD (cDCD) grafts suffer more delayed graft function (DGF), but have a long-term evolution comparable to those of brain-dead donors, which has allowed an increase in the number of cDCD transplants in different countries in recent years. In parallel, the use of cDCD with expanded criteria (cDCD/ECD) has increased in recent years in different countries, allowing the waiting list for kidney transplantation to be shortened. The use of these grafts, although associated with a higher frequency of DGF, offers similar or only slightly lower long-term graft survival than those of brain death donors with expanded criteria. Different studies have observed that cDCD/ECD graft recipients have worse kidney function than cDCD/standard and DBD/ECD. Mortality associated with cDCD/ECD graft transplantation mostly relates to the recipient age. Patients who receive a cDCD/≥60 graft have better survival than those who continue on the waiting list, although this fact has not been demonstrated in recipients of cDCD/>65 years. The use of this type of organ should be accompanied by the optimization of surgical times and the shortest possible cold ischemia.
摘要：
肾移植等待名单上患者数量的增加导致试图通过纳入以前认为不是最佳的候选人来增加潜在捐赠者的数量，包括心脏死亡（DCD）后的供体和具有“扩展”标准（ECD）的供体。受控DCD（cDCD）移植物的受体遭受更多的延迟移植物功能（DGF），但具有与脑死亡捐赠者相当的长期进化，这使得近年来不同国家的cDCD移植数量有所增加。并行,近年来，不同国家的cDCD/ECD(cDCD/ECD)的使用有所增加，允许缩短肾移植的等待名单。这些移植物的使用，尽管与较高的DGF频率相关，与具有扩展标准的脑死亡供体相比，提供了相似或仅略低的长期移植物存活率。不同的研究已经观察到cDCD/ECD移植受体的肾功能比cDCD/标准和DBD/ECD更差。与cDCD/ECD移植物移植相关的死亡率主要与受体年龄有关。接受cDCD/≥60移植的患者比继续在等待名单上的患者有更好的存活率，尽管这一事实尚未在cDCD/>65岁的接受者中得到证实。这种类型器官的使用应伴随着手术时间的优化和尽可能短的冷缺血。
