利用循环死亡后的供体进行肾移植:非洲大陆的首份报告。

IF 1.5 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
T Du Toit, K Manning, L Bertels, G Hoffman, D Thomson, Z A Barday
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引用次数: 0

摘要

背景:在南非开普敦的格鲁特舒尔医院(Groote Schuur Hospital),已故器官捐献者的数量在过去二十年间有所下降,因此有必要采取更为宽松的方法来选择捐献者。2007 年,医院实施了扩大已故肾脏捐献者库的措施,包括艾滋病病毒阳性者之间的移植计划,以及利用扩展标准捐献者和循环死亡后捐献者(DCDs):报告本机构在 DCD 肾移植方面的经验,并鼓励其他非洲中心采用这种方法,以提高移植的可及性:方法:对格罗特舒尔医院 17 年间连续进行的 DCD 肾移植进行了观察性队列研究。主要终点为 1 年、2 年和 5 年的移植物和患者存活率。次要终点包括移植物功能延迟(DGF)的发生率、30天的发病率、住院时间以及供体和受体的临床特征:结果:共进行了 15 次 DCD 采集,没有丢弃肾脏。共进行了 30 例肾移植,冷缺血时间的中位数(四分位数间距)为 11.5(8 - 14)小时。DGF发生率为60.0%,30天发病率(DGF除外)为20.0%。移植物 1 年、2 年和 5 年的存活率分别为 100%、96.0% 和 73.7%。患者1年、2年和5年的存活率分别为93.3%、93.3%和88.4%:结论:移植物和患者的长期存活率与国际文献不相上下。DCD可能为在整个非洲扩大死者捐献提供了一个独特的机会,尤其是在缺乏脑死亡立法以及宗教或文化上反对脑死亡后捐献的地区。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Kidney transplant utilising donors after circulatory death: The first report from the African continent.

Background: At Groote Schuur Hospital in Cape Town, South Africa, the number of deceased organ donors has declined over the past 2 decades, necessitating a more liberal approach to donor selection. In 2007, measures to expand the deceased kidney donor pool were implemented, including an HIV positive-to-positive transplant programme and the utilisation of extended-criteria donors as well as donors after circulatory death (DCDs).

Objectives: To report on our institutional experience with DCD kidney transplants and to encourage this approach among other African centres to improve access to transplantation.

Methods: An observational cohort study of consecutive DCD kidney transplants at Groote Schuur Hospital over a 17-year period was performed. Primary endpoints were 1-, 2- and 5-year graft and patient survival. Secondary endpoints included the incidence of delayed graft function (DGF), 30-day morbidity, length of stay, and donor and recipient clinical characteristics.

Results: Fifteen DCD procurements were performed, with no kidneys discarded. Thirty kidney transplants were performed, with a median (interquartile range) cold ischaemic time of 11.5 (8 - 14) hours. The incidence of DGF was 60.0%, and 30-day morbidity (other than DGF) was 20.0%. Graft survival at 1, 2 and 5 years was 100%, 96.0% and 73.7%, respectively. Patient survival at 1, 2 and 5 years was 93.3%, 93.3% and 88.4%, respectively.

Conclusion: Long-term graft and patient survival was comparable with the international literature. DCD may present a unique opportunity to expand deceased donation throughout Africa, particularly in areas affected by a lack of brain death legislation and religious or cultural objections to donation after brain death.

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来源期刊
Samj South African Medical Journal
Samj South African Medical Journal 医学-医学:内科
CiteScore
3.00
自引率
4.50%
发文量
175
审稿时长
4-8 weeks
期刊介绍: The SAMJ is a monthly peer reviewed, internationally indexed, general medical journal. It carries The SAMJ is a monthly, peer-reviewed, internationally indexed, general medical journal publishing leading research impacting clinical care in Africa. The Journal is not limited to articles that have ‘general medical content’, but is intending to capture the spectrum of medical and health sciences, grouped by relevance to the country’s burden of disease. This will include research in the social sciences and economics that is relevant to the medical issues around our burden of disease The journal carries research articles and letters, editorials, clinical practice and other medical articles and personal opinion, South African health-related news, obituaries, general correspondence, and classified advertisements (refer to the section policies for further information).
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