Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre.
Kidney and liver transplants from donors after cardiac death: initial experience at the London Health Sciences Centre.
复制标题
心脏死亡后捐献者的肾脏和肝脏移植：伦敦健康科学中心的初步经验。
DOI：
--
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
William Wall
中科院分区：
文献类型：
--
作者：
R. Hernandez‐Alejandro;Y. Caumartin;Cameron Chent;M. Levstik;D. Quan;N. Muirhead;A. House;Vivian Charles McAlister;A. Jevnikar;P. Luke;William Wall
背景
在加拿大，等待器官移植的患者人数与捐赠器官的可用性之间的差距每年都在增加。心源性死亡后捐献（DCD）是在绝望的心脏病患者停止生命支持后，解决短缺问题的一种手段，有可能增加可移植器官的数量。
方法
我们对2006年7月至2007年12月间在伦敦健康科学中心的多器官移植计划中心脏死亡后捐赠的器官进行了回顾性、单中心图表审查。总共从12名DCD供体中获得了34个实体器官（24个肾脏和10个肝脏）。
结果
供体的平均年龄为38岁（范围18-59）。死亡原因为颅脑损伤7例，脑血管意外4例，脑缺氧1例。所有10个肝脏都是在我们中心移植的，24个肾脏中的14个也是如此; 10个肾脏是在其他中心移植的。平均肾冷缺血时间为6（范围3-9.5）小时。14例肾移植受者中有12例（86%）出现移植肾功能延迟，但所有肾均恢复功能。随访1年后，肾功能良好，平均血清肌酐水平为145（范围107-220）μ mol/L，平均估计肌酐清除率为64（范围41-96）mL/min。平均肝脏冷缺血时间为5.8（范围5.5-8）小时。有1例原发性无功能需要再次移植。其余9个肝脏功能良好。1例患者发生胆管吻合口狭窄，经内镜支架植入术后消退。平均随访11个月（范围3-20个月）后，所有肝脏受体均存活。自DCD计划开始以来，转介到我们中心的捐赠者数量增加了14%。
结论
我们的初步结果与脑死亡后从捐赠者处获得的器官移植结果相比是有利的。心源性死亡后捐献器官是增加可供移植器官数量的重要手段，应鼓励在加拿大广泛实施。
BACKGROUND
The disparity between the number of patients waiting for an organ transplant and availability of donor organs increases each year in Canada. Donation after cardiac death (DCD), following withdrawal of life support in patients with hopeless prognoses, is a means of addressing the shortage with the potential to increase the number of transplantable organs.
METHODS
We conducted a retrospective, single-centre chart review of organs donated after cardiac death to the Multi-Organ Transplant Program at the London Health Sciences Centre between July 2006 and December 2007. In total, 34 solid organs (24 kidneys and 10 livers) were procured from 12 DCD donors.
RESULTS
The mean age of the donors was 38 (range 18-59) years. The causes of death were craniocerebral trauma (n = 7), cerebrovascular accident (n = 4) and cerebral hypoxia (n = 1). All 10 livers were transplanted at our centre, as were 14 of the 24 kidneys; 10 kidneys were transplanted at other centres. The mean renal cold ischemia time was 6 (range 3-9.5) hours. Twelve of the 14 kidney recipients (86%) experienced delayed graft function, but all kidneys regained function. After 1-year follow-up, kidney function was good, with a mean serum creatinine level of 145 (range 107-220) micromol/L and a mean estimated creatinine clearance of 64 (range 41-96) mL/min. The mean liver cold ischemia time was 5.8 (range 5.5-8) hours. There was 1 case of primary nonfunction requiring retransplantation. The remaining 9 livers functioned well. One patient developed a biliary anastomotic stricture that resolved after endoscopic stenting. All liver recipients were alive after a mean follow-up of 11 (range 3-20) months. Since the inception of this DCD program, the number of donors referred to our centre has increased by 14%.
CONCLUSION
Our initial results compare favourably with those from the transplantation of organs procured from donors after brain death. Donation after cardiac death can be an important means of increasing the number of organs available for transplant, and its widespread implementation in Canada should be encouraged.
影响因子：
4.3
作者：
B. Wąsowska;Chih-Yuan Lee;M. Halushka;W. Baldwin
通讯作者：
B. Wąsowska;Chih-Yuan Lee;M. Halushka;W. Baldwin