Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion
Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion
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DOI：
10.1111/j.1399-0012.2011.01477.x
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发表时间：
2011-09-01
影响因子：
2.1
通讯作者：
Perkins, J. D.
中科院分区：
文献类型：
--
作者：
Cantafio, A. W.;Dick, A. A. S.;Perkins, J. D.
在心脏死亡(DCD)后，捐赠者对肾脏的利用急剧增加。虽然这些器官是扩大捐赠者储备的机会，但风险评估和最佳围手术期处理仍不清楚。我们的主要目的是确定客观结果的危险因素，其次，我们试图确定脉冲式机器灌流(PMP)对这些结果的影响。从1993年到2008年11月，器官采购和移植网络数据库报告了6057例DCD肾移植，其移植肾功能延迟(DGF)和移植物存活率(GS)有完整的终点。风险因素通过对受体因素进行调整后的多变量回归分析来确定。年龄(50岁)[OR1.81，p<；0.0001]和冷缺血时间(>；30h)[OR3.22，p<；0.0001]是最强的预测因子。PMP的使用仅在供者年龄为60岁时降低了DGF的发生率，并在供者年龄为50岁时提高了移植物的长期存活率。供体热缺血时间>；20分钟也被发现与DGF的增加有关。虽然DCD肾脏中DGF的发生率明显更高，但移植外科医生唯一能控制的因素是CIT和PMP的使用。这些数据表明，在50岁的DCD肾脏中使用PMP几乎没有临床益处，可能会增加CIT。
There has been a dramatic increase in the utilization of kidneys from donors after cardiac death (DCD). While these organs represent an opportunity to expand the donor pool, the assessment of risk and optimal perioperative management remains unclear. Our primary aim was to identify risk factors for objective outcomes, and secondarily, we sought to determine what impact pulsatile machine perfusion (PMP) had on these outcomes. From 1993 to November 2008, 6057 DCD kidney transplants were reported to the Organ Procurement and Transplantation Network database, with complete endpoints for delayed graft function (DGF) and graft survival (GS). Risk factors were identified using a multivariable regression analysis adjusted for recipient factors. Age (50 yr) [OR 1.81, p < 0.0001] and cold ischemia time (CIT) (> 30 h) [OR 3.22, p < 0.0001] were the strongest predictors of DGF. The use of PMP decreased the incidence of DGF only when donor age was > 60 yr and improved long-term graft survival when donor age was > 50 yr. Donor warm ischemia time > 20 min was also found to correlate with increased DGF. While the incidence of DGF in DCD kidneys is significantly higher, the only factors the transplant surgeon can control are CIT and the use of PMP. The data suggest that the use of PMP in DCD kidneys < 50 yr old provides little clinical benefit and may increase CIT.