Rachel B Cutting, Nicole L De La Mata, Animesh Singla, James A Hedley, Helen Opdam, Philip Clayton, Kate Wyburn, Elena Cavazzoni, Paul Robertson, Henry Pleass, Angela C Webster
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引用次数: 0
Abstract
Background: An efficient organ donation programme must maximise transplantation following initiation of organ recovery procedures.
Methods: We conducted a cohort study of deceased donors in Australia (2014-2021) using Australia and New Zealand Organ Donation Registry data to characterise kidney non-retrieval (post-incision) and non-utilisation (retrieved, not transplanted). Donor characteristics included kidney side (left/right), kidney-only procurement, kidney donor profile index (KDPI), cause of death, resuscitation, donation after circulatory/neurological determination of death (DCDD/DNDD) and donor criteria (standard SCD/extended ECD), year, age, sex, blood group, ethnicity, comorbidities, smoking, BMI, weight, remoteness, occupation and socioeconomic disadvantage. System characteristics included jurisdiction of donor hospital, retrieval team and recipient's hospital.
Results: Among 7211 kidneys (3683 donors) accepted for retrieval, 675 (9%) were non-retrieved and 430 (7%) were non-utilised. Crude non-retrieval rates doubled from 5% to 10% between 2014 and 2021 (p = 0.01) while non-utilisation remained around 7% (p = 0.1). After adjustment, non-retrieval was greater among donors with KDPI ≥ 75 (OR: 4.28, 95% CI: 2.08-8.81, p < 0.001), diabetes (OR: 1.74, 95% CI: 1.25-2.43, p = 0.001) and in recent years (annual OR: 1.08, 95% CI: 1.03-1.55, p = 0.002), and lower for ECD DCDD (OR: 0.46, 95% CI: 0.26-0.81, p = 0.01). Non-utilisation was greater for SCD DCDD (OR: 1.90, 95% CI: 1.28-2.82, p < 0.001), blood group AB (OR: 2.05, 95% CI: 1.16-3.64, p = 0.03) and in recent years (annual OR: 1.08, 95% CI: 1.02-1.15, p = 0.01), and lower in Tasmania (OR: 0.28, 95% CI: 0.08-0.97) and Queensland (OR: 0.57, 95% CI: 0.36-0.92, p = 0.03). Documented reasons for non-utilisation lacked transparency but included poor perfusion (17%).
Conclusion: Increasing utilisation of higher KDPI kidneys and enhancing perfusion could help maximise kidney transplantation.
期刊介绍：
ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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