背景:解决供体器官短缺的努力包括增加循环性死亡(DCD)后供体肾脏同种异体移植物的使用。热缺血时间(WIT)被认为是DCD肾脏评估的重要因素,很少有研究比较WIT和DCD肾脏结局之间的关系,和WIT验收实践仍然可变。
方法:我们对2000年至2021年接受过死于供体肾脏移植的所有成年患者进行了单中心回顾性研究。我们通过比较供体和受体的特征以及高fWIT(>60分钟)之间的移植后结果,评估了不同的功能性热缺血时间(fWIT)在受控DCD供体中的影响,低fWIT(≤60分钟),和脑死亡(DBD)后从供体移植的肾脏。
结果:确定了两千八百十一名患者,638收到低fWITDCD,93收到高fWITDCD,2080年接受了DBD肾脏。DCD低fWIT之间的5年移植物存活率没有显着差异,高fWIT,和DBD组,84%,83%,83%的移植物起作用,分别。低fWIT组患者的五年生存率为91%,高fWIT组的92%,和90%的DBD组。与低CIT(HR2.12,95%CI=1.4-3.1)相比,肾脏供体风险指数(KDRI)(HR3.37,95%CI=2.1-5.7)和高CIT的增加对1年移植物衰竭具有更高的风险比。
结论:选择的FWIT延长的DCD供者对肾脏的接受度增加可能提供了增加肾脏利用率同时保持预后的机会。我们小组特别优先考虑使用年轻捐赠者的肾脏,KDPI较低,并且没有急性肾损伤,或潜在慢性肾病的危险因素。
BACKGROUND: 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.
METHODS: 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).
RESULTS: 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.
CONCLUSIONS: 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.