Improving outcomes for donation after circulatory death kidney transplantation: Science of the times

被引：24

作者：

de Kok, Michele J. C. ^{[1
,2
]}

Schaapherder, Alexander F. M. ^{[1
,2
]}

Alwayn, Ian P. J. ^{[1
,2
]}

Bemelman, Frederike J. ^{[3
]}

van de Wetering, Jacqueline ^{[4
]}

van Zuilen, Arjan D. ^{[5
]}

Christiaans, Maarten H. L. ^{[6
]}

Baas, Marije C. ^{[7
]}

Nurmohamed, Azam S. ^{[8
]}

Berger, Stefan P. ^{[9
]}

Bastiaannet, Esther ^{[10
]}

Ploeg, Rutger J. ^{[1
,2
,11
]}

de Vries, Aiko P. J. ^{[12
,13
]}

Lindeman, Jan H. N. ^{[1
,2
]}

机构：

[1] Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands

[2] Leiden Univ, Med Ctr, Leiden Transplant Ctr, Leiden, Netherlands

[3] Acad Med Ctr, Amsterdam UMC, Dept Internal Med Nephrol, Amsterdam, Netherlands

[4] Erasmus Univ, Med Ctr, Dept Internal Med Nephrol, Rotterdam, Netherlands

[5] Univ Med Ctr Utrecht, Dept Internal Med Nephrol, Utrecht, Netherlands

[6] Maastricht Univ, Med Ctr, Dept Internal Med Nephrol, Maastricht, Netherlands

[7] Radboud Univ Nijmegen, Med Ctr, Dept Internal Med Nephrol, Nijmegen, Netherlands

[8] Vrije Univ Amsterdam Med Ctr, Amsterdam UMC, Dept Internal Med Nephrol, Amsterdam, Netherlands

[9] Univ Med Ctr Groningen, Dept Internal Med Nephrol, Groningen, Netherlands

[10] Leiden Univ, Med Ctr, Dept Surg, Leiden, Netherlands

[11] Univ Oxford, Nuffield Dept Surg Sci, Oxford, England

[12] Leiden Univ, Med Ctr, Dept Internal Med, Div Nephrol, Leiden, Netherlands

[13] Leiden Univ, Med Ctr, Leiden Transplant Ctr, Leiden, Netherlands

来源：

PLOS ONE | 2020年 / 15卷 / 07期

关键词：

DONOR KIDNEYS; COLD ISCHEMIA; CARDIAC DEATH; RISK; UK;

D O I：

10.1371/journal.pone.0236662

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990-2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998-2008 [n = 3,499] and 2008-2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998-2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008-2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.

引用

页数：10

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