Risk stratification of kidneys from donation after cardiac death donors and the utility of machine perfusion

被引:30
作者
Cantafio, A. W. [1 ]
Dick, A. A. S. [1 ]
Halldorson, J. B. [1 ]
Bakthavatsalam, R. [1 ]
Reyes, J. D. [1 ]
Perkins, J. D. [1 ]
机构
[1] Univ Washington, Dept Surg, Div Transplantat, Seattle, WA 98195 USA
关键词
cold storage; donation after cardiac death; kidney transplantation; organ preservation/methods; outcomes; pulsatile machine perfusion; EXPANDED CRITERIA DONOR; COLD-STORAGE; GRAFT-SURVIVAL; CADAVER-KIDNEY; TRANSPLANTATION; PRESERVATION; ALLOCATION; OUTCOMES; IMPACT;
D O I
10.1111/j.1399-0012.2011.01477.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
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.
引用
收藏
页码:E530 / E540
页数:11
相关论文
共 20 条
[1]   SUCCESSFUL 17-HOUR PRESERVATION AND TRANSPLANTATION OF HUMAN-CADAVER KIDNEY [J].
BELZER, FO ;
ASHBY, BS ;
GULYASSY, PF ;
POWELL, M .
NEW ENGLAND JOURNAL OF MEDICINE, 1968, 278 (11) :608-&
[2]   Report of a national conference on donation after cardiac death [J].
Bernat, JL ;
D'Alessandro, AM ;
Port, FK ;
Bleck, TP ;
Heard, SO ;
Medina, J ;
Rosenbaum, SH ;
DeVita, MA ;
Gaston, RS ;
Merion, RM ;
Barr, ML ;
Marks, WH ;
Nathan, H ;
O'Connor, K ;
Rudow, DL ;
Leichtman, AB ;
Schwab, P ;
Ascher, NL ;
Metzger, RA ;
Mc Bride, V ;
Graham, W ;
Wagner, D ;
Warren, J ;
Delmonico, FL .
AMERICAN JOURNAL OF TRANSPLANTATION, 2006, 6 (02) :281-291
[3]   Non-heart beating donor kidneys with delayed graft function have superior graft survival compared with conventional heart-beating donor kidneys that develop delayed graft function [J].
Brook, NR ;
White, SA ;
Waller, JR ;
Veitch, PS ;
Nicholson, ML .
AMERICAN JOURNAL OF TRANSPLANTATION, 2003, 3 (05) :614-618
[4]   Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors [J].
Chan, Edie Y. ;
Olson, Les C. ;
Kisthard, James A. ;
Perkins, James D. ;
Bakthavatsalam, Ramasamy ;
Halldorson, Jeffrey B. ;
Reyes, Jorge D. ;
Larson, Anne M. ;
Levy, Adam E. .
LIVER TRANSPLANTATION, 2008, 14 (05) :604-610
[5]  
CHO SI, 1975, SURG FORUM, V26, P351
[6]   CADAVER-KIDNEY TRANSPLANT FAILURES AT ONE MONTH [J].
CLARK, EA ;
TERASAKI, PI ;
OPELZ, G ;
MICKEY, MR .
NEW ENGLAND JOURNAL OF MEDICINE, 1974, 291 (21) :1099-1102
[7]  
D'Alessandro Anthony M, 2004, Ann Transplant, V9, P68
[8]   Perfusion Storage Reduces Apoptosis in a Porcine Kidney Model of Donation After Cardiac Death [J].
Jani, Alkesh ;
Zimmerman, Michael ;
Martin, Jessica ;
Lu, Li ;
Turkmen, Kultigin ;
Ravichandran, Kameswaran ;
Pacic, Arijana ;
Ljubanovic, Danica ;
Edelstein, Charles L. .
TRANSPLANTATION, 2011, 91 (02) :169-175
[9]   Is pulsatile perfusion necessary for renal transplantation engrafting kidneys from cardiac death donors? [J].
Kusaka, M. ;
Kubota, Y. ;
Sasaki, H. ;
Maruyama, T. ;
Hayakawa, K. ;
Shiroki, R. ;
Hoshinaga, K. .
TRANSPLANTATION PROCEEDINGS, 2006, 38 (10) :3388-3389
[10]   Outcomes of kidneys from donors after cardiac death: Implications for allocation and preservation [J].
Locke, J. E. ;
Segev, D. L. ;
Warren, D. S. ;
Dominici, F. ;
Simpkins, C. E. ;
Montgomery, R. A. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2007, 7 (07) :1797-1807