Factors leading to the discard of deceased donor kidneys in the United States
Factors leading to the discard of deceased donor kidneys in the United States
复制标题
DOI：
10.1016/j.kint.2018.02.016
复制
发表时间：
2018-07-01
影响因子：
19.6
通讯作者：
Cohen, David J.
中科院分区：
文献类型：
--
作者：
Mohan, Sumit;Chiles, Mariana C.;Cohen, David J.
在美国，获取用于移植但随后被丢弃的死亡供体肾脏的比例一直在稳步上升，但导致丢弃率上升的因素仍不清楚。为了评估器官丢弃的原因和概率，我们在器官移植受者科学注册系统（SRTR）登记处收集了2000年至2015年期间获取用于移植的212305例死亡供体肾脏的数据，其中包括36700例被丢弃的肾脏。“活检结果”（38.2%）是最常报告的丢弃原因。被丢弃肾脏的肾脏供体风险指数中位数明显高于移植器官（1.78比1.12），但观察到被丢弃和移植的肾脏质量有很大重叠。年龄较大、女性、黑人、肥胖、糖尿病、高血压或丙肝阳性的供体的肾脏被丢弃的几率显著增加。具有多种不利特征的供体的肾脏更有可能被丢弃，而单侧被丢弃的肾脏具有最理想的供体特征，其配对肾脏的受者的一年死亡截尾移植物存活率超过90%。美国各地肾脏被丢弃的几率存在很大的地域差异，这进一步支持了器官质量之外的因素导致肾脏被丢弃的观点。因此，虽然从供体获取的一小部分器官被丢弃可能是不可避免的，但需要避免丢弃潜在可移植的肾脏。这将需要更好地了解导致器官丢弃的因素，以消除使用不太理想的器官进行移植的阻碍因素。
The proportion of deceased donor kidneys procured for transplant but subsequently discarded has been growing steadily in the United States, but factors contributing to the rising discard rate remain unclear. To assess the reasons for and probability of organ discard we assembled a cohort of 212,305 deceased donor kidneys recovered for transplant from 2000-2015 in the SRTR registry that included 36,700 kidneys that were discarded. 'Biopsy Findings' (38.2%) was the most commonly reported reason for discard. The median Kidney Donor Risk Index of discarded kidneys was significantly higher than transplanted organs (1.78 vs 1.12), but a large overlap in the quality of discarded and transplanted kidneys was observed. Kidneys of donors who were older, female, Black, obese, diabetic, hypertensive or HCV-positive experienced a significantly increased odds of discard. Kidneys from donors with multiple unfavorable characteristics were more likely to be discarded, whereas unilaterally discarded kidneys had the most desirable donor characteristics and the recipients of their partner kidneys experienced a one-year death-censored graft survival rate over 90%. There was considerable geographic variation in the odds of discard across the United States, which further supports the notion that factors beyond organ quality contributed to kidney discard. Thus, while the discard of a small fraction of organs procured from donors may be inevitable, the discard of potentially transplantable kidneys needs to be avoided. This will require a better understanding of the factors contributing to organ discard in order to remove the disincentives to utilize less-thanideal organs for transplantation.