Clinical results of an organ procurement organization effort to increase utilization of donors after cardiac death
Clinical results of an organ procurement organization effort to increase utilization of donors after cardiac death
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DOI：
10.1097/01.tp.0000179641.82031.ea
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发表时间：
2006-05-27
期刊：
影响因子：
6.2
通讯作者：
Lipkowitz, George
中科院分区：
文献类型：
--
作者：
Whiting, James F.;Delmonico, Francis;Lipkowitz, George
背景为了刺激器官捐献，在5年的时间里，在器官采购组织（OPO）范围内努力增加心脏性死亡（DCD）后的捐献者。这包括协议的共同性，脉动灌注的肾脏，集中的数据和区域分配的差异，旨在尽量减少冷缺血时间，并鼓励采用DCD协议在移植中心。在一个OPO中，8个中心在11家医院启动了DCD项目。共采购了52个DCD供体，从1999年的4个增加到2003年的21个。11名捐赠者在手术室撤回了护理，而41名捐赠者在ICU撤回了护理。总共有91名患者接受了来自这52名供体的肾移植（12名肾脏被丢弃，1名双移植），而5名患者接受了肝移植。1年、2年和3年移植肾存活率分别为90%、90%和82%。55%的患者术后需要至少一次血液透析。平均住院时间为11.1 +/- 6天。3、6、12和24个月时的平均肌酐水平分别为1.65、1.40、1.41和1.40。DCD供体可以是供体器官的重要来源，并提供良好的总体结局。区域合作和前瞻性考虑的分配和分配系统是激励DCD方案的重要考虑因素。
Background. To stimulate organ donation, an organ procurement organization (OPO)-wide effort was undertaken to increase donors after cardiac death (DCD) over a 5-year period. This included commonality of protocols, pulsatile perfusion of kidneys, centralization of data and a regional allocation variance designed to minimize cold ischemia times and encourage adoption of DCD protocols at transplant centers.Results. In one OPO, eight centers initiated DCD programs in 11 hospitals. A total of 52 DCD donors were procured, increasing from four in 1999 to 21 in 2003. Eleven donors had care withdrawn in the operating room, whereas 41 had care withdrawn in the ICU. In all, 91 patients received renal transplants from these 52 donors (12 kidneys discarded, one double transplant), whereas 5 patients received liver transplants. One-, two-, and three-year kidney graft survival rates were 90%, 90%, and 82%, respectively. Fifty-five percent of patients needed at least one session of hemodialysis postoperatively. Mean recipient hospital length of stay was 11.1 +/- 6 days. Mean creatinine levels at 3, 6, 12, and 24 months were 1.65, 1.40, 1.41, and 1.40, respectively.Conclusions. DCD donors can be an important source of donor organs and provide excellent overall outcomes. Regional cooperation and a prospectively considered allocation and distribution system are important considerations in stimulating DCD programs.