Assessing Kidney Transplantation Using ECMO-Supported Donors Within a KDPI-Based Allocation System.

IF 1.9 Q3 TRANSPLANTATION
Transplantation Direct Pub Date : 2023-10-10 eCollection Date: 2023-11-01 DOI:10.1097/TXD.0000000000001521
Peter J Altshuler, Devon J Pace, William A Preston, Sage A Vincent, Ashesh P Shah, Jaime M Glorioso, Warren R Maley, Adam M Frank, Carlo B Ramirez, Sharon West, Richard Hasz, Adam S Bodzin
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引用次数: 0

Abstract

Background: Organ donors supported by extracorporeal membrane oxygenation (ECMO) have historically been considered high-risk and are judiciously utilized. This study examines transplant outcomes using renal allografts from donors supported on ECMO for nondonation purposes.

Methods: Retrospective review of the Gift of Life (Pennsylvania, New Jersey, Delaware) organ procurement organization database, cross-referenced to the Organ Procurement and Transplantation Network database, assessed kidney transplants using donors supported on venoarterial (VA) and venovenous (VV) ECMO for nondonation purposes. Transplants using VA- and VV-ECMO donors were compared with Kidney Donor Profile Index (KDPI)-stratified non-ECMO donors. Regression modeling of the entire ECMO and non-ECMO populations assessed ECMO as predictive of graft survival. Additional regression of the ECMO population alone assessed for donor features associated with graft survival.

Results: Seventy-eight ECMO donors yielded 128 kidney transplants (VA: 80, VV: 48). Comparing outcomes using these donors to kidney transplants using organs from KDPI-stratified non-ECMO donors, VA- and VV-ECMO donor grafts conferred similar rates of delayed graft function and posttransplant renal function to KDPI-matched non-ECMO counterparts. VA-ECMO kidneys demonstrated superior graft survival compared with the lowest-quality (KDPI 86%-100%) non-ECMO kidneys and similar graft survival to KDPI <85% non-ECMO kidneys. VV-ECMO showed inferior graft survival to all but the lowest-quality (KDPI 86%-100%) non-ECMO kidneys. VV-ECMO, but not VA-ECMO, was associated with increased risk of graft loss on multivariable regression (hazard ratios-VA: 1.02, VV: 2.18). Higher KDPI, advanced age, increased body mass index, hypertension, and diabetes were identified as high-risk features of ECMO donors.

Conclusions: Kidney transplantation using appropriately selected ECMO donors can safely expand the donor pool. Ongoing studies are necessary to determine best practice patterns using kidneys from these donors.

Abstract Image

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Abstract Image

在基于KDPI的分配系统中使用ECMO支持的供体评估肾移植。
背景:体外膜肺氧合(ECMO)支持的器官供体历来被认为是高风险的,并得到了明智的利用。这项研究使用ECMO支持的捐赠者的同种异体肾脏移植物来检查移植结果。方法:回顾性回顾生命的礼物(宾夕法尼亚州、新泽西州、特拉华州)器官采购组织数据库,交叉参考器官采购和移植网络数据库,评估使用静脉动脉(VA)和静脉静脉(VV)ECMO支持的捐赠者进行的肾移植,用于非捐赠目的。使用VA和VV-ECMO供体的移植与肾脏供体档案指数(KDPI)分层的非ECMO供体进行比较。对整个ECMO和非ECMO人群的回归建模评估ECMO可预测移植物存活率。单独评估ECMO人群的额外回归与移植物存活相关的供体特征。结果:78名ECMO捐献者进行了128例肾移植(VA:80,VV:48)。将使用这些供体的结果与使用KDPI分层非ECMO供体器官的肾移植进行比较,VA和VV-ECMO供体移植物的延迟移植物功能和移植后肾功能的发生率与KDPI匹配的非ECMO移植物相似。与质量最低(KDPI 86%-100%)的非ECMO肾脏相比,VA-ECMO肾脏的移植物存活率更高,移植物生存率与KDPI相似。结论:使用适当选择的ECMO供体进行肾脏移植可以安全地扩大供体库。为了确定使用这些捐赠者肾脏的最佳实践模式,有必要进行持续的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Transplantation Direct
Transplantation Direct TRANSPLANTATION-
CiteScore
3.40
自引率
4.30%
发文量
193
审稿时长
8 weeks
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