Use and Outcomes of Kidneys from Donation after Circulatory Death Donors in the United States
Use and Outcomes of Kidneys from Donation after Circulatory Death Donors in the United States
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DOI：
10.1681/asn.2017030238
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发表时间：
2017-12-01
影响因子：
13.6
通讯作者：
O'Connor, Kevin
中科院分区：
文献类型：
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作者：
Gill, John;Rose, Caren;O'Connor, Kevin
循环死亡(DCD)捐赠者是移植肾脏的重要来源，但DCD捐赠者移植在美国不像在其他国家那么常见。在这项对2008至2015年间获得的国家数据进行的研究中，在该国58个捐赠者服务区中，DCD肾脏的恢复情况差异很大，25%的DCD肾脏仅在4个捐赠者服务区恢复。总体而言，回收的DCD肾脏中有20%被丢弃，在捐赠者服务地区中，从3%到33%不等。与神经性脑死亡(NBD)供者的肾脏相比，DCD肾脏的调整后废弃比从1.25(95%可信区间[95%CI]，1.16~1.34)变化到2.67(95%可信区间，2.34~3.04)。移植12,831个DCD肾中，移植12个小时的肾脏。我们得出结论，供者服务区水平在DCD肾的回收和丢弃方面的差异很大。需要更多的国家数据收集，以了解在美国增加DCD捐赠者移植的潜力。减少冷缺血损伤的策略可能会安全地允许增加DCD肾脏的使用。48分钟。
Donation after circulatory death (DCD) donors are an important source of kidneys for transplantation, but DCD donor transplantation is less common in the United States than in other countries. In this study of national data obtained between 2008 and 2015, recovery of DCD kidneys varied substantially among the country's 58 donor service areas, and 25% of DCD kidneys were recovered in only four donor service areas. Overall, 20% of recovered DCD kidneys were discarded, varying from 3% to 33% among donor service areas. Compared with kidneys from neurologically brain dead (NBD) donors, DCD kidneys had a higher adjusted odds ratio of discard that varied from 1.25 (95% confidence interval [95% CI], 1.16 to 1.34) in kidneys with total donor warm ischemic time (WIT) of 10-26 minutes to 2.67 (95% CI, 2.34 to 3.04) in kidneys with total donor WIT.48 minutes. Among the 12,831 DCD kidneys transplanted, kidneys with WIT 12 hours. We conclude that donor service area-level variation in the recovery and discard of DCD kidneys is large. Additional national data collection is needed to understand the potential to increase DCD donor transplantation in the United States. Strategies to minimize cold ischemic injury may safely allow increased use of DCD kidneys with WIT. 48 minutes.