Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium
Kidney donation after circulatory death in a country with a high number of brain dead donors: 10-year experience in Belgium
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DOI：
10.1111/j.1432-2277.2012.01510.x
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发表时间：
2012-08-01
影响因子：
3.1
通讯作者：
Pirenne, Jacques
中科院分区：
文献类型：
--
作者：
Jochmans, Ina;Darius, Tom;Pirenne, Jacques
全球范围内标准脑死亡供体（DBD）的短缺恢复了循环死亡后（DCD）肾脏捐献的使用。我们回顾了比利时DCD肾移植（KT）的经验，因为它在2000年重新引入。采用多变量分析确定移植肾功能延迟恢复（DGF）的危险因素。使用KaplanMeier曲线评估5年患者/移植物存活率。比利时的肾脏供体类型的演变和DCD对总KT活性的影响与荷兰进行了比较。在2000年至2009年期间，进行了287次DCD KT。原发性肾功能不全占1%，DGF占31%。5年患者和死亡删失移植物存活率分别为93%和95%。在多变量分析中，冷藏（与机器灌注），冷缺血时间，和组氨酸-色氨酸-酮戊二酸溶液是DGF发展的独立危险因素。尽管DCD捐赠和移植的数量增加，但死亡的KT总数并没有显著增加。这可能意味着从DBD转向DCD。为了增加KT活动，比利时应进一步扩大受控DCD计划，同时改善所有潜在DBD的识别，并避免在脑死亡发生前将其作为DCD进行捐赠。此外，活体捐赠仍然没有得到充分利用。
Worldwide shortage of standard brain dead donors (DBD) has revived the use of kidneys donated after circulatory death (DCD). We reviewed the Belgian DCD kidney transplant (KT) experience since its reintroduction in 2000. Risk factors for delayed graft function (DGF) were identified using multivariate analysis. Five-year patient/graft survival was assessed using KaplanMeier curves. The evolution of the kidney donor type and the impact of DCDs on the total KT activity in Belgium were compared with the Netherlands. Between 2000 and 2009, 287 DCD KT were performed. Primary nonfunction occurred in 1% and DGF in 31%. Five-year patient and death-censored graft survival were 93% and 95%, respectively. In multivariate analysis, cold storage (versus machine perfusion), cold ischemic time, and histidine-tryptophan-ketoglutarate solution were independent risk factors for the development of DGF. Despite an increased number of DCD donations and transplantations, the total number of deceased KT did not increase significantly. This could suggest a shift from DBDs to DCDs. To increase KT activity, Belgium should further expand controlled DCD programs while simultaneously improve the identification of all potential DBDs and avoid their referral for donation as DCDs before brain death occurs. Furthermore, living donation remains underused.