Outcomes of dual adult kidney transplants in the United States: An analysis of the OPTN/UNOS database
Outcomes of dual adult kidney transplants in the United States: An analysis of the OPTN/UNOS database
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DOI：
10.1097/01.tp.0000296855.44445.af
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发表时间：
2008-01-15
期刊：
影响因子：
6.2
通讯作者：
Bunnapradist, Suphamai
中科院分区：
文献类型：
--
作者：
Gill, Jagbir;Cho, Yong W.;Bunnapradist, Suphamai
背景。器官短缺导致使用扩大标准供体（ECD）肾脏的人数增加。对于不适合单次使用的ECD肾脏，双肾移植（DKT）是可能的。比较DKT与单肾ECD移植的结果的数据有限，因此不清楚DKT在当前分配方案中的位置。我们的目的是比较美国DKT和ECD移植的结果。从2000年到2005年，从器官获取和移植网络/器官共享联合网络数据中，共确定了625例DKT、7686例单肾ECD和6044例SCD移植，这些移植来自年龄在100 ~ 50岁的供者。同种异体移植存活是主要结果。DKT占50岁供者肾移植的4%。与ECD供体组相比，DKT供体组年龄更大（平均年龄64.6 +/- 7.7岁vs 59.9 +/- 6.2岁），包括更多的非裔美国人（13.1% vs 9.9%）和更多的糖尿病供体（16.3% vs 10.4%; P < 0.001）。DKT的平均冷缺血时间更长（22.2 +/- 9.7小时），但移植功能延迟率（29.3%）低于ECD移植（33.6%，P=0.03）。DKT移植的3年总生存率为79.8%，ECD移植的3年总生存率为78.3%。尽管使用来自高风险供者的器官，但DKT并不常见，其结果与ECD移植相当。作为ECD算法的一部分，通过在等待名单时为患者提供这种选择，我们可以进一步优化DKT的结果，并最大限度地减少潜在器官的丢弃。
Background. The organ shortage has resulted in increased use of kidneys from expanded criteria donors (ECD). For ECD kidneys unsuitable for single use, dual kidney transplants (DKT) may be possible. There are limited data comparing outcomes of DKT to single kidney ECD transplants, making it unclear where DKT fits in the current allocation scheme. Our purpose was to compare outcomes of DKT and ECD transplants in the United States.Methods. From 2000 to 2005, a total of 625 DKT, 7686 single kidney ECD, and 6,044 SCD transplants from donors aged >= 50 years were identified from the Organ Procurement and Transplantation Network/United Network for Organ Sharing data. Allograft survival was the primary outcome.Results. DKT comprised 4% of kidney transplants from donors aged >= 50 years. Compared to the ECD donor group, the DKT donor group was older (mean age 64.6 +/- 7.7 years vs. 59.9 +/- 6.2 years) and consisted of more African Americans (13.1% vs. 9.9%), and more diabetic donors (16.3% vs. 10.4%; P < 0.001). Mean cold ischemic time was longer in DKT (22.2 +/- 9.7 hr), but rates of delayed graft function were lower (29.3%) compared to ECD transplants (33.6%, P=0.03). Three-year overall graft survival was 79.8% for DKT and 78.3% for ECD transplants.Conclusion. DKT were infrequent and had outcomes comparable to ECD transplants, despite the use of organs from higher risk donors. With a more upfront approach to DKT by offering this option to patients at the time of wait-listing as part of an ECD algorithm, we may be able to further optimize outcomes of DKT and minimize discard of potential organs.